Royal New Research Articles

Direct oral anticoagulants (DOACs) use for prolonged venous thromboembolism prophylaxis following surgery for gynaecological malignancies in Australia and New Zealand - A clinician survey.

Current international guidelines recommend 28 days of enoxaparin as venous thromboembolism (VTE) prophylaxis after surgery for gynaecologic cancer. Direct oral anticoagulants (DOACs) have been investigated as an alternative to enoxaparin for post-operative VTE prophylaxis. High-quality evidence to demonstrate safety and efficacy is lacking. We aim to investigate the current practice regarding VTE prophylaxis among gynaecological oncologists in Australia and New Zealand following laparotomy for gynaecological malignancy, in particular the use of DOACs for VTE prophylaxis. Sixty-seven practising gynaecologic oncologists (GO) were identified through Royal Australia and New Zealand College of Obstetricians and Gynaecologists database and emailed online surveys that asked about VTE prophylaxis practice and views of DOACs in this setting. Data were then collected through Survey Monkey and evaluated. The majority (77.1%) routinely prescribed 28 days of enoxaparin following laparotomy for gynaecological malignancies. In clinical circumstance such as laparoscopy for gynaecological malignancies and surgery for vulva malignancies, there was variation in thromboprophylaxis practices. No GO reported routine use of DOACs in any clinical circumstance. There were 56% of GOs who used a DOAC in their practice at some point. Barriers to routine use of DOACs in current practice included insufficient evidence (68%), issue with cost (40.4%) and concerns about safety (29.7%). Enoxaparin prescribed for 28 days remains the current clinical practice in preventing VTE following laparotomy for gynaecological malignancy. The main barrier to routine DOAC use as post-operative thromboprophylaxis is a lack of evidence which reflects the need for a larger prospective study.

Mindfulness-Based Attention Training in the Navy: A Feasibility Study.

Mind wandering is common during daily activities and is even more prevalent under stressful conditions, which could lead to lapses in attention and poor performance. Newly recruited military personnel who undergo demanding training often experience high levels of stress. It is therefore imperative to find ways to foster mental health and avoid performance deterioration related to mind wandering in times of intense military training. This feasibility study investigated the effectiveness of an established low-dose mindfulness-based intervention (MBI), called Mindfulness-based Attention Training (MBAT), on mind wandering, attentional performance, and well-being, delivered by a facilitator who was taught how to deliver MBAT. A sample of newly recruited Royal New Zealand Navy (RNZN) Junior Officers (n = 17) undergoing demanding training participated in the 8-week long MBI with one weekly contact session. Measures of well-being and the Sustained Attention to Response Task (SART) were completed 4weeks prior to the MBAT, at the start of the MBAT, at the end of the MBAT and 4weeks after completion of the MBAT. Results suggest that MBAT might protect from performance decline during intense training and enhance levels of well-being at follow-up. These findings highlight the valuable role of mindfulness as a component in military training.

How colleges should lead on climate.

How colleges should lead on climate.

Radiation oncology peer review in Australia and New Zealand.

Peer review is a part of high quality care within radiation oncology, designed to achieve the best outcomes for patients. We discuss the importance of and evidence for peer review in clinical practice. The Royal Australia and New Zealand College of Radiologists (RANZCR) has evolved a Peer Review Assessment Tool (PRAT) since 1999. We report the results of a RANZCR faculty survey conducted in radiation oncology facilities across Australia and New Zealand to guide the 2019 PRAT revision process, and discuss the development and implementation of the 2019 PRAT. Peer-review processes are now mandated as a component of Australian and International Quality Standards. Several practical recommendations might address challenges for effective implementation of peer review process in routine clinical practice. This includes prioritising tumour sites and treatment techniques for peer review within the time and resources constraints of each institution, improving resource allocation, ensuring optimal timing and duration for peer review meetings, and adopting multi-centre virtual peer review meeting where necessary.

The Royal New Zealand Ballet and the Power of Dance in Prison

The following article is based on research conducted with the Royal New Zealand Ballet in May 2020. Within this article, we explore themes around the impact of dance on the incarcerated body as well as the physical and emotional transformative power of this art form utilizing Foucault’s docile bodies framework. We also explore the idea of dance as a humanizing art form, allowing prisoners to improve their self-esteem, as well as their connections to their others. Finally, we situate this research within the Canadian context and outline why a program such as the Royal New Zealand Ballet’s Prison Program is a positive step toward rehabilitation. This article seeks to understand and discuss the ways in which dance can help to bring a sense of joy and meaning to the lives of prisoners, thus, improving many aspects of their lives.

Health quality of retired Royal New Zealand Navy personnel: A cross-sectional analysis

Purpose: To characterise the current health quality of retired Royal New Zealand Navy (RNZN) personnel. Methods: A Cross-sectional analysis of self-reported survey data was conducted. A total of 300 retired RNZN personnel completed a Health-Related Quality of Life (HRQOL) survey on-line using the SF-36v2 to assess physical and mental health domains. The Physical Component Summary [PCS] combined Physical Function (PF), Role Physical (RP), Bodily Pain (BP) and General Health (GH) subscales. The Mental Component Summary [MCS] combined Vitality (VT), Social Functioning (SF), Role Emotional (RE) and Mental Health (MH) subscales. Analysis by age, gender, ethnicity, and rank were conducted for the subscale results. Comparisons of the RNZN cohort with the 1998 US National and New Zealand 2006-2007 health surveys were made. Results: New Zealand Europeans (NZE) recorded a higher mean RP and PCS than New Zealand Māori (NZM) (RP: 66.9 vs. 54.9; t(46)=-2.2; p=0.0294; d=0.50; PCS: 68.9 vs. 65.7; t(46)=-2.3; p=0.0267; d=0.47). Senior Rates recorded a higher MH (69.5 vs. 66.2; t(19)=-1.1; p=0.0568; d=0.35) but a lower PCS (65.0 vs. 65.6; t(19)=0.6;p=0.0681 d=0.07) and MCS (59.2 vs. 59.4; t(19)=-1.4; p=0.0865; d=0.46) than Officers. Compared with the New Zealand 2006-2007 health survey, the retired RNZN cohort had a lower RP (58.0 vs. 85.7; d=1.14), BP (42.6 vs. 75.3; d=1.51), SF (59.8 vs. 88.4; d=1.85) and MH (68.5 vs. 82.3; d=1.28). Conclusion: The lower HRQOL subscales results (especially BP) for retired RNZN personnel compared to the general population and other service personnel indicates a need for more research to understand the potential reasons for these findings. The effects of the lifestyle and training requirements combined with the entry selection of healthy people into the navy may have impacted on the results reported in this survey.

General practitioner and obstetrician views on system changes to improve smoking cessation care in pregnancy in Australia: a cross-sectional survey

AbstractIntroductionSystemic barriers impacting smoking cessation in pregnant women may include nicotine replacement therapy (NRT) access and training.AimAssess general practitioner (GP) and obstetrician's agreement with system-based changes to improve the management of smoking in pregnancy; compare group responses.MethodsNational cross-sectional survey with two samples: (1) online survey emailed to a random sample of 500 GPs from Royal Australian College of General Practitioners (RACGP); (2) paper survey posted to 5571 GPs and obstetricians from Royal Australia and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Percentages agreeing that specified changes would improve the management of smoking in pregnancy were calculated. Pairwise comparisons used Kruskal–Wallis tests (RACGP/RANZCOG GPs/obstetricians).ResultsN = 378 participated. Response rates 8.4% (N = 42; online survey) and 6% (N = 335; paper survey), respectively. Total percentages agreeing with system-based changes: 79% training, 64% oral NRT subsidy, 62% Medicare item for smoking cessation, 54% improved access to NRT patches. Within RANZCOG, more GPs (73.1%) agreed that oral NRT should be subsidised (P = 0.001) than obstetricians (53.7%).ConclusionGPs and obstetricians agreed that system changes would improve their management of smoking in pregnancy. Oral NRT subsidy was the only pairwise group difference. Subsequently, oral NRT has been subsidised; in time, this may influence prescribing and quit rates.

A dance of excellence, accessibility, money and national identity: A discourse analysis of the Royal New Zealand Ballet's website

This paper explores how the Royal New Zealand Ballet's (RNZB's) website is used to construct the organisation's identity. Recent changes to the New Zealand government's cultural policy regarding accessibility, accountability, and funding have seen arts organisations need to consider economic sustainability. We posit that the changing demands placed on elite arts organisations to accommodate both artistic and commercial values may create conflicting messages and tensions that impact on their identity. To explore these tensions, we applied Dryzek's discourse analysis to the RNZB's website. The study uncovered the key entities constructed on the website as the audience, sponsors, and dancers, then considered the power relationships between these entities as well as the explicit and implicit reasons the website had been constructed. The results of the study highlight that the RNZB has chosen to emphasise its normative identity as a creative arts organisation, which inevitably had to meet utilitarian needs of financial support in order to have longevity. By making money, access, excellence, and national identity a part of their overall identity, the RNZB have perhaps inadvertently created contradictions and ambiguity in their wider identity scheme. We conclude that the until the RNZB can run sustainably without government support, and the contradictions in their presented identity will most likely remain.

New Zealand general practice registrars’ views on their academic learning needs during vocational training: online survey

ABSTRACT Most doctors working in New Zealand general practice undertake vocational training through the Royal New Zealand College of General Practitioners. We aimed to explore general practice registrar views on their academic learning needs during and following vocational training. An online survey of all current NZ GP trainees in 2019 was completed by 314 registrars (54% response rate). The majority (88%, 275/314) were completing RNZCGP Fellowship only, and of these half (55%, 152/275) were planning a further postgraduate qualification. A minority (12%, 33/275) indicated a desire to undertake a masters or PhD degree. Almost all (99%, 310/314) intended to work in general practice; 9% (8/314) intending to also work as rural hospital doctors. The five most common areas of interest for further training were clinical skills (68%), practice-based teaching (66%), specific clinical conditions (63%), age or life-stage specific (47%) and non-clinical areas (41%). There is a considerable gap between completing RNZCGP Fellowship, intending to undertake further (formal postgraduate) education and actually enrolling. This is concerning given the need for lifelong learning and critical evaluation of practice and health service delivery. The future New Zealand general practice workforce needs GPs to be diverse and highly skilled members or leaders of expert teams.

Repeat prescribing policy in New Zealand general practice: making it better.

INTRODUCTION Repeat prescribing is common in New Zealand general practice. Research also suggests that repeat prescribing is a process prone to error. All New Zealand general practices have to comply with requirements to have a repeat prescribing policy, with the details of the policy to be designed by the practice. AIM To inform the development of practice policy, research was undertaken with experienced general practitioners to identify and mitigate risk in the process. METHODS At the 2019 annual conference of the Royal New Zealand College of General Practitioners, a workshop was held with 58 experienced general practitioner participants. The group was divided into six small groups, each with the task of discussing one aspect of the repeat prescribing process. The results were then discussed with the whole group and key discussion points were transcribed and analysed. RESULTS Issues identified included: improving patient education on appropriateness of repeat prescribing; having protected time for medicine reconciliation and the task of repeat prescribing; reducing the number of personnel and steps in the process; and clarity over responsibility for repeat prescribing. DISCUSSION This research can inform the local development of a repeat prescribing policy at the practice level or be used to critique existing practice policies. Attention was also drawn to the increasing administrative burden that repeat prescribing contributes to in general practice.

Tackling rural health inequities from the ground up

New Zealand rural health is in crisis. Many rural general practices are closing their doors or relying heavily on short-term locums. There was public outrage when general practices in Northland closed their books, but this is what more of rural New Zealand will face if swift and ongoing action is not taken. In the Royal New Zealand College of General Practitioners 2018 survey, 39% of rural respondents worked in a practice with an unfilled vacancy, and 36% of rural general practitioners intended to retire in one to five years. In addition, it showed that rural general practitioners are more likely to do on-call and unpaid work than their urban counterparts.

Using the Multiple Mini Interview for selection into vocational general practice training.

INTRODUCTION Interviews for selection into post graduate training courses are an accepted method of selection. There is the presumption that such interview processes are fair to both candidates and the training scheme. AIM Due to concerns over unconscious bias and a desire to move to best practice, the Royal New Zealand College of General Practitioners introduced the Mini Multiple Interview (MMI) process as the selection process for doctors wishing to enter vocational training in general practice. METHODS Aspects assessed during the interviews were developed through wide consultation and included: reason for wanting to undertake training, managing poor compliance, addressing issues of equity, managing complaints, insight and understanding the role of general practitioners in chronic care. There were 218 applicants who took the MMI. Demographic data as well as scores were collected. RESULTS The MMI process has good reliability and performs well in several aspects of validity. All three interview venues had similar results. There was no gender difference in overall result or scores. New Zealand graduates scored higher than overseas graduates. Of the 218 candidates, 12 were considered not yet ready to enter training. DISCUSSION The MMI process appears to have acceptable reliability and good validity. The structure of the MMI is likely to have reduced unconscious bias. Further research will study the predictive validity of the MMI for this cohort of candidates.

Rigorous decommissioning decision making with strong stakeholder engagement using comparative assessment

Improving the robustness of decommissioning decision making will provide greater confidence in the decision and ensure stronger commitment to its execution. This can be achieved by putting some key principles into practice, including comparing a wide range of options against each other using a ‘decision model’ and actively engaging stakeholders in the decision process. Comparative assessment (CA) is a helpful approach to supporting robust decision making. Implementing CA through multi-criteria decision analysis (MCDA) and decision conferencing is a powerful and proven way of putting such principles into practice. MCDA and decision conferencing involves ‘modelling’ the decision by articulating all outcomes (benefits, risks and costs – intangible and tangible) as a set of criteria and using a facilitated stakeholder group to evaluate options against one another. The group ‘scores’ options against the criteria, weights the criteria and then reviews the results, leading to a shared understanding of the issues and commitment to the way forward. CA has been widely used outside the oil and gas (O&G) sector for robust decision making; for example, the Royal New Zealand Airforce used CA to agree to the best solution for replacing their advanced pilot training capability. This led to clear, confident support for the preferred solution by the Treasury, and ultimately, cabinet ministers. CA is now starting to be used to support O&G decommissioning decisions, and one example is the use of CA by Shell and ExxonMobil to agree on the best course of action for decommissioning the storage cells of the Brent Delta platform.

Repeat prescribing safety survey.

INTRODUCTION Repeat prescribing is an accepted part of general practice activities in New Zealand and in many developed countries. However, there has been little research on how this service is used in New Zealand, or on clinicians' attitudes towards it. AIM To discover the opinions of vocationally registered general practitioners (GPs) and general practice registrars regarding repeat prescribing, availability of practice policy and mechanisms for issuing such prescriptions. METHODS A survey was developed by an expert group and shared through the Royal New Zealand College of General Practitioners' (the College) weekly newsletter, epulse, inviting members to participate in the survey. The survey was also emailed to registrars. RESULTS In total, 144 vocationally registered GPs and 115 registrars responded (n=259), giving a response rate of 3.2% for GPs and 12.7% for registrars. Patient convenience and time efficiency for the practice were the most commonly cited reasons for repeat prescribing. Registrars had low awareness of practice policy on repeat prescribing and only one-quarter of practices had an orientation pack that contained advice on repeat prescribing. DISCUSSION Better practice systems are likely to improve the safety profile of repeat prescribing and should be addressed. There is substantial unwanted variability currently in these practice systems.

Experience and confidence in vaginal breech and twin deliveries among obstetric trainees and new specialists in Australia and New Zealand.

The number of vaginal breech and twin deliveries may be insufficient for adequate training. To determine whether advanced trainees and new Fellows in obstetrics are gaining adequate experience and confidence in vaginal breech and twin deliveries. An online survey was emailed to registered Royal Australia and New Zealand College of Obstetrics and Gynaecology (RANZCOG) advanced trainees and new Fellows (Years 1-5). This survey asked about their experience, confidence and whether they intend to perform vaginal breech and twin deliveries as specialists. The survey was sent to 703 advanced trainees (162) and Fellows (541) and answered by 217 (31.7%). Experience and confidence in vaginal breech and twin deliveries increased with the number of procedures performed (P<0.001) in both groups and were significantly higher among Fellows. Despite the level of experience, 100% of respondents felt confident in managing vaginal twin deliveries with or without supervision, whereas 14.9% of respondents did not feel confident in managing vaginal breech deliveries. Intention to offer these procedures in their practice depended on confidence levels, and there was a significant difference between twins and breech. Overall, 87.3% of respondents intended to offer vaginal twin deliveries in their practice, while only 32.7% intended to offer vaginal breech deliveries. Confidence in complex vaginal deliveries increases with increasing number of procedures performed and a significant proportion of trainees and Fellows consider they do not have sufficient experience. The association between confidence and intention to offer these procedures is stronger in twins than in breech deliveries.

The state of the nation: the Norwegian King’s annual addresses – a window on a shifting nationhood

ABSTRACTThis article supplements the limited research on the monarchy by highlighting the symbolic and cultural value of Norway’s Royal House in nation-building. To maintain his unifying and non-partisan role, the king must balance between conflicting perspectives on national identity. Our analysis of royal New Year’s speeches 1960–2014 examines the concepts of ‘Norwegianness’ conveyed, noting the increasing focus on diversity and a multicultural society.

The Ancient Near East: History, Texts, etc.

The Ancient Near East: History, Texts, etc. Christopher T. Begg, Isaac M. Alderman, Eric J. Wagner, CR, and Ryan C. Payne 22. Claus Ambos, "Rituale der Herrschaftslegitimation babylonischer und assyrischer Könige," Herrschaftslegitimation, 67-78 [see #703]. Among the rituals of legitimatization for kingship in ancient Mesopotamia designed to highlight both divine and human recognition of a king's rule was the coronation ceremony at the beginning of his reign and the complex of New Year rituals whereby his legitimation was re-affirmed on a bi-annual basis, once in the spring and again in the fall. Focusing on these New Year rituals, A. highlights the difference between them in Babylonia and Assyria. In the former case, the king underwent a variety of ritual humiliations in which, e.g., he was deprived of his regalia, slapped on the cheek by an officiating priest and required to address the great gods with abject prayers in which he confessed his sins and his abandonment by his personal gods before finally being restored to his royal dignity. In Assyria, by contrast, the emphasis in the royal New Year rituals was on the intimate, unbreakable bond between the god Assur and the king, the god's (chief) priest.—C.T.B. 23. Shlomo Bahar, "El Amarna 252,23-29, again," UF 44 (2013) 1-3. Lines 23-30 of tablet EA 252 of Labayu of Shechem are notorious for their difficulty. The particularly hard part of the tablet is its lines 27-29. The purpose of this paper is to point to sources which may shed light on these lines and which have not been used for that purpose hitherto. Two problems are posed by these lines: the interpretation of lines 27-28 and the understanding of the meaning of the form u-ṣur-ru-na in context (p. 1). In the course of his article, B. proposes "new and additional" arguments for the translation of Z. Cochavi-Rainey (2005), who, taking the above verbal form in the sense "watch, keep an eye on," renders the lines in question thus: "Moreover, if you say another thing, 'fall beneath them and they will smite you, my enemies. I shall keep an eye on (watch) the people who captured the town.'"—C.T.B. [End Page 8] 24. Angelika Berlejung, "Dimensionen der Herrschaftslegitimität: Ikonographische Aspekte königlicher Selbstdarstellung in den Kulturen der südlichen Levante der Eisenzeit anhand der Bildwerke van Baluʿa, Yarih-ʿ ezer und Askalon," Herrschaftslegitimation, 147-87 [see #703]. B. begins her essay with a consideration of the "dimensions of legitimation" as these have been developed especially by the political theorist D. Beetham according to whom the attainment and maintenance on the part of a ruler required conformity to societal rules, which are themselves grounded in convictions shared by both ruler and subordinates and an expression of consent to the ruler's exercise of authority from the side of the ruled. In her introductory segment, B. further focuses attention on ANE (more particularly southern Levantine) stone images of Iron Age kings and the ways in which they serve to legitimate the rule of the monarch represented by the image, e.g., by endowing his depiction with qualities of lastingness and timelessness, qualities which, in turn, were meant to evoke confidence and awe on the part of those who behold the image. In the second part of her essay, B. proceeds to examine in more detail the three royal statues of her title, i.e., the (proto-) Moabite king Baluʿa, the Ammonite ruler Yarih-ʿezer and an unidentified (kingly?) figure whose (headless) image was discovered in the Mediterranean waters close to the Philistine city of Ashkelon in 1985. In each instance, B. seeks to clarify how the given image does promote the legitimation requirements of the one depicted by conveying a variety of positive messages about his status and capacities.—C.T.B. 25. Stefan Bojowald, "Noch einmal zur Vertreibung von bösen Mächten in unbewohnte Gegenden: eine neu entdeckte innerägyptische Parallele für pBerlin 3027, Spruch B, I 4-5," BN 174 (2017) 107-11. B. returns once again to the...

Royal New Zealand Navy nutrition, health and wellbeing intervention

Introduction: Across the New Zealand population, the prevalence of overweight and obesity and the associated ill health is increasing, with current “best practice” recommendations for management proving ineffective. The rate of overweight and obesity within the New Zealand Defence Force (NZDF) and other militaries is not dissimilar to that of the general population. Excess body fat increases the risk of metabolic syndrome, diabetes, cardiovascular disease, and other chronic conditions. The aim of the study was to assess the effects of a 12-week trial of a Low Carbohydrate, High Fat (LCHF) diet on metabolic health outcomes of Royal New Zealand Navy (RNZN) personnel with a BMI >25 kg/m2.

Analysis of the physical demand of the RNZN basic common training course – Implications for recruitment, preparation and course delivery

Introduction: Basic Common Training (BCT) is the first course any sailor accepted into the Royal New Zealand Navy (RNZN) must undertake. The 18-week course aims to teach new recruits the skills required to serve in the RNZN and also prepare them mentally and physically. The physical impact of the course has not been previously assessed.

Prevalence and risk factors for cats testing positive for feline immunodeficiency virus and feline leukaemia virus infection in cats entering an animal shelter in New Zealand

AIMSTo estimate the prevalence of cats testing positive for antibodies to feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV) antigens in domestic cats entering a New Zealand animal shelter, based on a commercial point-of-care ELISA, to identify risk factors associated with cats testing positive, and to compare the results obtained from the ELISA with those obtained using PCR-based testing.METHODA cross-sectional study was performed on 388 cats entering the Royal New Zealand Society for the Prevention of Cruelty to Animals animal shelter in Auckland, New Zealand between 7 February 2014 and 30 May 2014. Whole blood samples were collected from each cat and tested for FIV antibody and FeLV antigen using a commercial point-of-care ELISA. Information on the signalment and health status of the cat at the time of entry was also recorded. Blood and saliva samples from a subset of cats were tested for FIV and FeLV proviral DNA using a real-time PCR assay.RESULTSOf the 388 cats in the study sample, 146 (37.6%) had been relinquished by owners, 237 (62.4%) were strays, and 5 (1.3%) were of unknown origin. Overall, 53/388 (13.7%) cats tested positive for FIV antibodies and 4/388 (1.0%) were positive for FeLV antigen. Stray cats had a higher FIV seroprevalence than relinquished cats (42/237 (17.8%) vs. 11/146 (7.5%); p=0.008). Of 53 cats that were FIV-seropositive, 51 (96%) tested positive for FIV proviral DNA using PCR testing of blood. Of these 51 cats, 28 (55%) were positive by PCR testing of saliva. Of the four cats that were FeLV antigen-positive by ELISA, two (50%) were positive for FeLV proviral DNA by PCR testing of blood. The odds of a cat being seropositive for FIV were greater for intact compared to desexed cats (OR=3.3; 95% CI=1.6–7.4) and for male compared to female cats (OR=6.5; 95% CI=3.2–14.0).CONCLUSIONS AND CLINICAL RELEVANCEThe seroprevalence for FIV was 14% among cats entering an animal shelter in Auckland, whereas the prevalence of FeLV antigen-positive cats was only 1%. These findings suggest differences in the transmission dynamics of each virus in free-roaming cat populations in New Zealand. Our study also highlights the potential role of desexing cats in reducing transmission of FIV. However, further data from first-opinion veterinary practices are required to confirm that these findings may be generalised to the wider domestic cat population in New Zealand.