Canterbury District Health Board Research Articles

Rheumatoid interstitial lung disease in Canterbury, Aotearoa New Zealand – A retrospective cohort study

BackgroundRheumatoid arthritis associated interstitial lung disease (RA-ILD), is an important extra-articular manifestation of rheumatoid arthritis (RA). The frequency, risk factors, and prognosis of RA-ILD are incompletely understood. AimsTo determine the prevalence and incidence, clinical characteristics and risk factors for development, and outcomes of persons with RA-ILD in the population of the Canterbury District Health Board (CDHB) catchment area. MethodsIndividuals aged ≥ 18 years with RA, resident in the CDHB catchment area between 1 January 2006 and 31 December 2008 (Period One), and 1 January 2011 to 31 December 2013 (Period Two) were identified by medical record review and followed until 30 June 2019. Individuals with RA-ILD as defined by pre-specified criteria were identified. The association between demographic and clinical characteristics and RA-ILD development and mortality was examined using Cox-proportional hazards models. ResultsThe prevalence of RA-ILD per 100,000 was 10.97 (95 % CI 7.53,14.42) for Period One, and 14.74 (95 % CI 10.84,18.63) for Period Two. Among individuals evaluated for risk factors for RA-ILD development, the estimated cumulative incidence of ILD at 10 years was 4.47 % (95 % CI 3.14, 6.14). After adjusting for age, rheumatoid factor positivity (HR 3.73, 95 % CI, 1.32,10.56), extra-articular manifestations other than RA-ILD (HR 4.48, 95 % CI 2.36,8.48), and subcutaneous rheumatoid nodules (HR 4.66, 95 % CI 2.34, 9.26) were associated with increased risk of developing RA-ILD. The standardised mortality ratio for RA-ILD was 3.90 (95 % CI 2.55,5.72) compared to the general population. Extent of ILD on CT chest was associated with mortality (HR for >20% vs. < 20 % 4.47, 95 % CI 1.67,11.96). ConclusionsClinically evident RA-ILD occurred in approximately 5 % of individuals with RA. Mortality was increased almost fourfold compared to the general population. Radiologic extent was the most important prognostic factor.

Factors contributing to death of major trauma victims with haemorrhage: A retrospective case-control study.

To identify factors associated with death secondary to haemorrhage following major trauma. A retrospective case-control study was conducted on data from adult major trauma patients attending Christchurch Hospital ED between 1 June 2016 and 1 June 2020. Cases (those who died due to haemorrhage or multiple organ failure [MOF]), were matched to controls (those who survived) in a 1:5 ratio from the Canterbury District Health Board major trauma database. A multivariate analysis was used to identify potential risk factors for death due to haemorrhage. One thousand, five hundred and forty major trauma patients were admitted to Christchurch Hospital or died in ED during the study period. Of them, 140 (9.1%) died from any cause, most attributed to a central nervous system cause of death; 19 (1.2%) died from haemorrhage or MOF. After controlling for age and injury severity, having a lower temperature on arrival in ED was a significant modifiable risk factor for death. Additionally, intubation prior to hospital, increased base deficit, lower initial haemoglobin and lower Glasgow Coma Scalewere risk factors associated with death. The present study reaffirms previous literature that lower body temperature on presentation to hospital is a significant potentially modifiable variable in predicting death following major trauma. Further studies should investigate whether all pre-hospital services have key performance indicators (KPIs) for temperature management, and causes for failure to reach these. Our findings should promote development and tracking of such KPIs where they do not already exist.

An area-based description of closed books in general practices in Aotearoa New Zealand.

Introduction In Aotearoa New Zealand, patients can enrol in a general practice for their primary health care. When a general practice no longer enrols new patients this is known as 'closed books'. We examined which District Health Board (DHB) districts were most affected and what characteristics of general practices and DHB districts were associated with closed books. Methods Maps were used to display the distribution of closed books general practices. Linear regression and logistic regression were used to look at the association between DHB or general practice characteristics and closed books. Results There were 347 (33%) general practices that had closed books in June 2022. Canterbury DHB (n = 45) and Southern DHB (n = 32) had the greatest number of closed books general practices, while Wairarapa DHB (86%), Midcentral DHB (81%) and Taranaki DHB (81%) had the greatest percentage. Consultation fees (P Conclusion The problem of closed books is felt across the country but has a larger impact in the middle-lower North Island. This influences access to primary health care enrolment for patients in terms of travel distance, time, and cost. Consultation fees were strongly associated with closed books. This suggests there may be an income threshold above which general practices can afford to close their books if they reach capacity.

Comparison of the Aotearoa New Zealand Early Warning Score and National Early Warning Score to predict adverse inpatient events in a vital sign dataset.

Aotearoa New Zealand uses a single early warning score (EWS) across all public and private hospitals to detect adult inpatient physiological deterioration. This combines the aggregate weighted scoring of the UK National Early Warning Score with single parameter activation from Australian medical emergency team systems. We conducted a retrospective analysis of a large vital sign dataset to validate the predictive performance of the New Zealand EWS in discriminating between patients at risk of serious adverse events and compared this with the UK EWS. We also compared predictive performance for patients admitted under medical vs. surgical specialties. A total of 1,738,787 aggregate scores (13,910,296 individual vital signs) were obtained from 102,394 hospital admissions to six hospitals within the Canterbury District Health Board of New Zealand's South Island. Predictive performance of each scoring system was determined using area under the receiver operating characteristic curve. Analysis showed that the New Zealand EWS is equivalent to the UK EWS in predicting patients at risk of serious adverse events (cardiac arrest, death and/or unanticipated ICU admission). Area under the receiver operating characteristic curve for both EWSs for any adverse outcome was 0.874 (95%CI 0.871-0.878) and 0.874 (95%CI 0.870-0.877), respectively. Both EWSs showed superior predictive value for cardiac arrest and/or death in patients admitted under surgical rather than medical specialties. Our study is the first validation of the New Zealand EWS in predicting serious adverse events in a broad dataset and supports previous work showing the UK EWS has superior predictive performance in surgical rather than medical patients.

FIVE- AND TEN-YEAR FOLLOW-UP OF UNICOMPARTMENTAL KNEE ARTHROPLASTIES IN OBESE PATIENTS

Due to shorter hospital stays and faster patient rehabilitation Unicompartmental Knee Replacements (UKR) are now considered more cost effective than Total Knee Joint Replacements (TKJR). Obesity however, has long been thought of as a relative contraindication to UKR due to an unproven theoretical concern of early loosening.This study is a retrospective review of patient reported outcome scores and revision rates of all UKR with recorded BMI performed by the Canterbury District Health Board (CDHB) from January 2011 and September 2021. Patient reported outcome scores were taken preoperatively, at 6 months, 1 year, 5 years and 10 years post operatively. These included WOMAC, Oxford, HAAS, UCLA, WHOQOL, normality, pain and patient satisfaction. 873 patients had functional scores recorded at 5 years and 164 patients had scores recorded at 10 years. Further sub-group analysis was performed based on patient BMI of &lt;25, 25-30, 30-35 and &gt;35. Revision data was available for 2377 UKRs performed in Christchurch during this period.Both obese (BMI &gt;30) and non-obese (BMI &lt;30) patients had significantly improved post-operative scores compared to preoperative. Pre-operatively obese patients had significantly lower functional scores except for pain and UCLA. All functional scores were lower in obese patients at 5 years but this did not meet minimum clinical difference. At 10 years, there was significantly lower HAAS, satisfaction and WOMAC scores for obese patients but no difference in Oxford, normality, WHOQOL, UCLA and pain scores. There was no significant difference in the improvement from pre-operative scores between obese and non-obese patients. All cause revision rate for obese patients at 10 years was 0.69 per 100 observed component years compared to 0.76 in non-obese. This was not statistically significant.Our study proves that UKR is an excellent option in obese patients with post-operative improvement in functional scores and 10 year survivorship equivalent to non-obese patients.

Risk of colorectal cancer in patients with appendicitis over the age of 40 years.

Acute appendicitis in late adulthood is hypothesized to be associated with an increased risk of colorectal cancer (CRC). This study aimed to establish whether patients over the age of 40 years presenting with appendicitis had an increased risk of being diagnosed with CRC over the subsequent 3 years. This is a retrospective review of patients aged 40 years and over presenting to Canterbury District Health Board with appendicitis from January 2010 to December 2015. Clinical details were obtained for these patients and cross-referenced with the New Zealand Cancer Registry for the 3 years following diagnosis. The incidence ratio rate (IRR) and standardized incidence ratio (SIR) were calculated by establishing the incidence of CRC in this cohort and comparing it with the Canterbury population data. A total of 1099 patients met the inclusion criteria. The majority (75%) underwent CT as part of their initial work-up. The rate of colonoscopy increased with age from around 10% between 40 and 49 years to 27% for those 70 years and over. Eleven cases of CRC were identified, resulting in an IRR 2.35 (95% CI 1.17-4.21). The SIR for this population was 3.28 (95% CI 1.82-5.92). The rate of CRC is significantly increased compared with the background population in this cohort. The results of this study support luminal investigation of adults aged 40 years and over who present with acute appendicitis as CT alone was insufficient to detect the pathology.

SARS-CoV-2 vaccination and myocarditis in a highly vaccinated New Zealand population

Abstract Background A higher incidence of myocarditis has been reported in those who have recently received mRNA SARS – CoV-2 vaccination.1 Canterbury District Health Board (CDHB) serves 578,290 people, including 441,852 adults, with one large tertiary referral hospital offering specialist cardiology services. In 2021 97% of eligible adults received at least one dose and 92% two doses of the BNT162b2 mRNA vaccine (Pfizer-BioNTech). During this time only 21 community cases of COVID-19 infection were reported. We investigated the incidence of myocarditis during the BNT162b2 mRNA vaccine rollout in comparison to the preceding 5 years assuming a stable population size. Methods All adult patients admitted to our hospital who received a diagnostic code of acute myocarditis (ICD10 codes I40, I41 and I51.4) during admission between 2016 and 2021 were included. Demographics and peak troponin concentration (hsTnI) were recorded. Vaccine-associated myocarditis was defined as that leading to admitted within 28 days of BNT162b2 vaccination. Myocarditis-associated mortality was defined as death occurring within 28 days of hospital admission. Incidence of myocarditis before and during COVID-19 vaccination was tested using ANOVA. Results Between 2016 and 2020 there were 178 total hospital admissions (annualised mean 35.6 [SD6.3] range 28–44) with myocarditis. The mean age was 47.8 [SD15.9] years, 38% were women, and median peak hsTnI 641 (IQR 95.25–8526) ng/L. One patient died within 28 days of admission. In 2021 there were 43 myocarditis admissions, mean age 49.7 [SD18] years, 42% women, with a median hsTnI 355 (IQR 106.5–1876.5) ng/L. Nine of these admissions were within 28 days of vaccination. They were 78% female, mean age 52.6 [SD24.8] years, median peak hsTnI 179 (IQR 52–528) ng/L. One patient died during admission. There was no variance in annual incidence of myocarditis during vaccine rollout (p=0.342). Conclusion In a highly vaccinated adult population largely free of COVID-19 infection there were few cases of myocarditis within 28 days of vaccination and no increase in incidence overall compared to the preceding 5 years. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Heart Foundation of New Zealand grant to C Greer

Seismic repair and retrofit prioritization framework

The 2010–2011 Canterbury earthquake sequence caused significant damage to the Canterbury District Health Board (CDHB) building stock. The extent of damage, post-earthquake changes to the seismic code, new legislation around earthquake-prone buildings, and ongoing changes to clinical service requirements created a challenging decision-making environment for capital works repair and retrofit. In this article, we present a framework designed to assess the seismic resilience of buildings from a holistic perspective and to determine appropriate levels of seismic retrofit. The framework design ensures that decisions are driven by building criticality in the context of a healthcare system. It helps users to balance life safety risk and the demands of delivering critical clinical services day to day: resulting in safe facilities that provide effective health services under a range of future conditions. Pilot application of the framework enabled the reprioritization of significant capital toward buildings that provide the most life safety and health service resilience benefits in the long term. The process and resulting framework from this project is applicable to a wider range of building owners navigating seismic retrofit decision-making and the emerging movement toward functional recovery–based building regulation.

Rheumatoid interstitial lung disease in Canterbury New Zealand: prevalence, risk factors and long-term outcomes—protocol for a population-based retrospective study

IntroductionRheumatoid arthritis (RA) affects approximately 0.5%–1% of the general population. Clinically significant interstitial lung diseases (ILD) develops in just under 10% of people with RA, and subclinical disease is more...

Establishing a community infusion service in Canterbury, New Zealand: strategies and lessons.

Background and context An increasing number of drugs and blood products need to be delivered by intravenous infusion. In the Canterbury region of New Zealand, these have historically been delivered at a hospital site; however, some infusions could be delivered in a community setting without compromising patient safety. Assessment of problem The Canterbury health system has a key strategic objective of delivering care close to patients' homes. In 2018, Canterbury district health board (DHB) put out a tender for a community infusion service that would deliver blood products and other intravenous drugs with appropriate medical oversight. Strategies for improvement Following an interview and selection process, a fee-for-service contract was developed with a group of general practices with partial common ownership. It was nurse-led with medical oversight available. In July 2018, a Community Infusion Service (CIS) was started in two urban sites in Canterbury. It later expanded to two more sites, one urban and one rural. Results From July 2018 to May 2021, over 3000 infusions and blood transfusions were delivered by the CIS across seven infusion types (blood; immunoglobulin; infliximab; natalizumab; pamidronate; toculizumab; zoledronic acid). Both general practice and hospital services referred patients to the CIS. No major incidents were reported. Patients reported satisfaction with the service. Lessons Infusions and blood products can be delivered safely nearer to patients' homes in primary care in a New Zealand setting. Medical input was rarely required; however, the transition was resource-intensive; it required both overall process and criteria negotiations, as well as individual patient discussions. In its initial stages, the CIS did not have adequate clinical governance and operational support, which affected the speed and scale of its development.

Cortex Application (Electronic Notes and Data Platform) Impact in the Cardiology Department, Canterbury District Health Board

Canterbury District Health Board has been transitioning from paper-based clinical notes to an electronic system. The Cortex application and data platform has been developed by a local company, Sense Medical, in conjunction with clinicians. Cortex is used for documenting clinical notes and replacing paper-based workflow with electronic ordering and communication. Cortex was rolled out to the Cardiology Department in December 2020. We tailor-made digital forms and orders to aim to improve our documentation and communication within the department including the wards, coronary care unit and cardiology day unit.

Clinical decision support in a hospital electronic prescribing system informed by local data: experience at a tertiary New Zealand centre.

An electronic prescribing and administration (ePA) system has been progressively rolled out to Canterbury District Health Board (CDHB, Christchurch, New Zealand) public hospitals since 2014, and is currently used for around 1300 tertiary beds. ePA data can be used to monitor user behaviour, and to evaluate and inform the local customisation of clinical decision support (CDS) tools within the ePA system. To describe retrospectively illustrative vignettes of CDHB ePA analyses that have been used for CDS. Alerts were developed according to a set of common principles agreed upon by the CDHB CDS Working Group. Alerts were informed and evaluated by extracting and parsing data for various time periods during 2016 to 2018 from the CDHB ePA database. There was a median of 74 000 prescriptions a month. After examining 525 spironolactone prescriptions, the high dose alert threshold was set at 100 mg with an expected alert burden of 3%. The presence of a ceftriaxone shortage prescribing alert for 1 week was associated with a prescribing rate that was lower than 95% of the preceding 52 weeks. Following review of 367 fentanyl patch alerts, revision of the alert led to false positives falling from 43% to 3% (P < 0.0001). At the point of firing, 6% of antithrombotic drug interactions alerts led to immediate changes in prescriptions (94% overridden), and a further 22% were changed within 30 min after the alert. Local data extracts from ePA systems can inform iterative configuration of the software and monitor user behaviour.

Impact of the Canterbury earthquakes on dispensing of psychiatric medication for children and adolescents: longitudinal quantitative study

Natural disasters are increasing in frequency and impact; they cause widespread disruption and adversity throughout the world. The Canterbury earthquakes of 2010-2011 were devastating for the people of Christchurch, New Zealand. It is important to understand the impact of this disaster on the mental health of children and adolescents. To report psychiatric medication use for children and adolescents following the Canterbury earthquakes. Dispensing data from community pharmacies for the medication classes antidepressants, antipsychotics, anxiolytics, sedatives/hypnotics and methylphenidate are routinely recorded in a national database. Longitudinal data are available for residents of the Canterbury District Health Board (DHB) and nationally. We compared dispensing data for children and adolescents residing in Canterbury DHB with national dispensing data to assess the impact of the Canterbury earthquakes on psychotropic prescribing for children and adolescents. After longer-term trends and population adjustments are considered, a subtle adverse effect of the Canterbury earthquakes on dispensing of antidepressants was detected. However, the Canterbury earthquakes were not associated with higher dispensing rates for antipsychotics, anxiolytics, sedatives/hypnotics or methylphenidate. Mental disorders or psychological distress of a sufficient severity to result in treatment of children and adolescents with psychiatric medication were not substantially affected by the Canterbury earthquakes.

An initiative to improve equity, timeliness and access to District Health Board-funded physiotherapy in Canterbury, Christchurch, New Zealand.

Background and context General practice teams frequently request orthopaedic and musculoskeletal physiotherapy. In the Canterbury District Health Board (DHB) region, before November 2018, the criteria for DHB-funded physiotherapy were unclear. Wait times were many months. Care was provided on hospital sites. Limited data were available about the service. Assessment of problem A clinical project group including private and DHB hospital physiotherapists and general practitioners was established. Patients requiring orthopaedic and musculoskeletal physiotherapy who had certain criteria were seen by physiotherapists in contracted private clinics in the community instead of by physiotherapists in hospital departments. Patients received up to NZ$300 (excluding GST) of care. A claiming process was established that required the physiotherapy clinics to provide data on patient outcomes. Results In the first 12 months of the programme, 1229 requests were accepted. Patients waited an average of 11.1 days for their first appointment. There was an average Patient Specific Functional Scale increase of 3.7 after treatment. Strategies for improvement A change environment was critical for this community-based, geographically distributed model to succeed. It was supported by key clinicians and funders with sufficient authority to make changes as required. It required ongoing clinical oversight and operational support. Lessons DHB orthopaedic and musculoskeletal physiotherapy can be moved from hospital sites to a community-based, distributed service in a timely, effective and equitable fashion. There was a prompt time to treatment. Data collection was improved by tracking 'before' and 'after' measures.

903 Transcatheter Aortic Valve Implantation in New Zealand: The First Decade

Transcatheter aortic valve implantation (TAVI) is a well-established therapy for aortic stenosis, the most common acquired valvular heart disease in New Zealand (NZ). In this study, we reviewed the demographics, geographic distribution and survival rates of patients undergoing TAVI. Patients undergoing TAVI in a NZ hospital from 2008 to 2018 were collected via the National Minimum Dataset and ICD-10 procedure codes. National and District Health Board (DHB) TAVI rates were age-standardized using census data. Mortality data were analyzed using standard statistical methods. From 2008 to 2018, 952 patients underwent TAVI in NZ (42.5% women, mean age 80.0±7.5 years, 93.5% European). TAVI commenced at 5 hospitals at varying time point; Waikato 2008, Auckland City 2011, Christchurch 2011, Dunedin 2015 and Wellington 2017. From 2013 to 2018, the national age-standardized TAVI rate increased from 1.5 to 4.9 per 100,000 people. In 2018, TAVI rates ranged from 2.0 to 12.8 per 100,000 people in Hutt Valley and South Canterbury DHB respectively. There was also a significant ethnic difference in TAVI rates (European 6.6, Pacific 0.8, Maori 0.5 per 100,000 people). The national one-year survival was 93.5%, with no difference between hospitals. European, Pacific and Maori patients’ one-year survival were 93.9%, 88.2%, and 80.1% respectively. Despite Maori patients being significantly younger than Europeans (67.9 vs 80.6 years, p<0.05), they were less likely to survive at one-year independent of age (19.2% vs 6.1%, HR4.2, 95% CI:1.6-11.5, p=0.004). There are significant geographical and ethnic variations in TAVI rates in NZ. Maori had worse one-year survival than European patients following TAVI.

A003 Transcatheter Aortic Valve Implantation in New Zealand: The First Decade

Transcatheter aortic valve implantation (TAVI) is a well-established therapy for aortic stenosis, the most common acquired valvular heart disease in New Zealand (NZ). In this study, we reviewed the demographics, geographic distribution and survival rates of patients undergoing TAVI. Patients undergoing TAVI in a NZ hospital from 2008 to 2018 were collected via the National Minimum Dataset and ICD-10 procedure codes. National and District Health Board (DHB) TAVI rates were age-standardised using census data. Mortality data were analysed using standard statistical methods. From 2008 to 2018, 952 patients underwent TAVI in NZ (42.5% women, mean age 80.0±7.5 years, 93.5% European). TAVI commenced at 5 hospitals at varying time point; Waikato 2008, Auckland City 2011, Christchurch 2011, Dunedin 2015 and Wellington 2017. From 2013 to 2018, the national age-standardised TAVI rate increased from 1.5 to 4.9 per 100,000 people. In 2018, TAVI rates ranged from 2.0 to 12.8 per 100,000 people in Hutt Valley and South Canterbury DHB respectively. There was also a significant ethnic difference in TAVI rates (European 6.6, Pacific 0.8, Māori 0.5 per 100,000 people). The national one-year survival was 93.5%, with no difference between hospitals. European, Pacific and Māori patients' one-year survival were 93.9%, 88.2%, and 80.1% respectively. Despite Māori patients being significantly younger than Europeans (67.9 vs 80.6 years, p<0.05), they were less likely to survive at one-year independent of age (19.2% vs 6.1%, HR4.2, 95%CI:1.6-11.5, p=0.004). There are significant geographical and ethnic variations in TAVI rates in NZ. Māori had worse one-year survival than European patients following TAVI.

Efficacy and Safety of Zanubrutinib in Patients with Treatment-Naive Chronic Lymphocytic Leukemia (CLL) or Small Lymphocytic Lymphoma (SLL) with Del(17p): Initial Results from Arm C of the Sequoia (BGB-3111-304) Trial

Efficacy and Safety of Zanubrutinib in Patients with Treatment-Naive Chronic Lymphocytic Leukemia (CLL) or Small Lymphocytic Lymphoma (SLL) with Del(17p): Initial Results from Arm C of the Sequoia (BGB-3111-304) Trial

Improving the patient journey through a risk assessment approach for ESBL-E

The increase in multidrug resistant organisms (MDRO), including Extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-E), presents a challenge for infection prevention and control (IPC) teams to find adequate isolation facilities. Not all ESBL-E positive patients may present a risk for ongoing transmission and require isolation. Reducing unnecessary isolation can help with patient flow and reduce adverse events associated with isolation precautions. &#x0D; &#x0D; The Canterbury District Health Board IPC team aimed to improve the bed management and patient journey for ESBL-E colonised/infected patients through the introduction of a risk-assessment approach for deciding the IPC and isolation requirements for these patients. Hospital policy and procedures were revised to include a process for categorising patients according to their individual risk factors for transmission of ESBL-E. Each category requires a specific set of IPC measures. To facilitate the new policy, a colour assessment tool in the form of a poster was developed as a quick reference for staff.&#x0D; &#x0D; The new policy and poster were introduced across all hospital sites over several months. Several single rooms a day were freed up which facilitated overall bed management and patient flow. Patients with a low risk of transmission of ESBL-E benefited from a potential better journey of care. Furthermore, IPC surveillance reports did not demonstrate any increase in nosocomial ESBL-E cases. &#x0D; &#x0D; Implementing a risk assessment for the placement and care of ESBL-E patients can have a positive outcome for patients, families, staff and bed managers, while mitigating the risk of transmission of antimicrobial resistance.

The impact of the Canterbury earthquakes on dispensing for older person's mental health.

To evaluate the impact of the Canterbury earthquakes on the mental health of older people by examining dispensing patterns of psychotropic medication. Dispensing data from community pharmacies for antidepressants, antipsychotics, anxiolytics, and sedative/hypnotics are routinely recorded in a national database. Longitudinal data are available for residents of the Canterbury District Health Board (DHB) (n = 67 760 at study onset) and the rest of New Zealand (n = 469 055 at study onset). We compared older age dispensing data between 2008 and 2018 for Canterbury DHB with older age dispensing data nationally in order to assess the impact of the Canterbury earthquakes on the mental health of older persons. Older age residents of Canterbury are dispensed antidepressants, antipsychotics, and anxiolytics at higher rates than national comparators, but this finding predated the onset of the earthquakes. Short-term increases in anxiolytic and sedative/hypnotic dispensing occurred for the month following the February 2011 earthquake. No other short- or longer-term increases in dispensing of psychiatric medication were present. The February 2011 Canterbury earthquake caused a short-term increase in dispensing of anxiolytics and sedative/hypnotics. No longer-term effects on dispensing were observed. This suggests that older persons sought assistance for insomnia and anxiety in the aftermath of the most devastating earthquake, but longer-term rates of clinically significant anxiety and depression for older persons did not increase as a consequence of the earthquakes sequence.

Developments in chemotherapy for the treatment of acute myeloid leukemia.

Mark Drummond obtained his medical degree from the University of Glasgow (UK) and since then has trained as a hematologist in the West of Scotland and the Canterbury District Health Board (Christchurch, New Zealand) and back at Glasgow University, where he also gained a PhD in chronic myeloid leukemia. He is currently a consultant hematologist and honorary senior lecturer at the Beatson Cancer Centre (Glasgow, UK) as well as an investigator on multiple UK and international clinical trials.Here he talks to Commissioning Editor Jennifer Straiton, commenting on the recent announcement from the Scottish Medicines Consortium, regarding their acceptance of the use of the combination chemotherapy treatment Vyxeos® (daunorubicin and cytarabine) for the treatment of high-risk acute myeloid leukemia in adults. He then discusses the ongoing and future clinical trials in this disease area and then turns to more personalized treatments.