Wellington Hospital Research Articles

Paul Louis Tessier

Paul Louis Tessier

The New Zealand national junior doctors' strike: implications for the provision of acute hospital medical services

The New Zealand junior doctors' strike provided an opportunity to consider strategies that might be employed to overcome the international shortage of junior doctors. This article reports the experience of the emergency department (ED) and internal medicine (IM) services at Wellington Hospital during the national strike, in which medical services were primarily provided by specialist consultants in addition to, or as part of, their routine work. During the strike, elective admissions and outpatient clinics were mostly cancelled. In the ED, the waiting times and length of stay were markedly reduced. In IM, the proportion of patients admitted to the short stay unit rather than the general medical wards increased. Notwithstanding the different work circumstances, in both services one senior doctor carried the workload of at least two junior doctors. The deployment of additional senior medical staff to acute hospital services could greatly reduce the total number of doctors required. This strategy would have implications in terms of supporting acute medicine specialty initiatives, training, quality of care and funding.

A case–control study of seated immobility at work as a risk factor for venous thromboembolism

To determine the relative risk of prolonged seated immobility at work in patients with a deep vein thrombosis (DVT) or pulmonary embolism (PE). A case-control study: cases and controls completed an interviewer-administered questionnaire to obtain information on risk factors for venous thromboembolism (VTE), including prolonged seated immobility at work. Univariate and multivariate logistic regression was used to determine the association between predicted variables and the probability of being a case or control. Cases were patients<65 years old attending the Wellington Hospital Outpatient VTE Clinic following hospital discharge for DVT and/or PE. Controls were patients<65 years old admitted to the Coronary Care Unit at Wellington Hospital. The Wellington Hospital Outpatient VTE Clinic and Coronary Care Unit. Odds ratio of VTE for prolonged seated immobility. There were 97 cases (53 DVT, 29 PE, 15 DVT and PE), and 106 controls. In the multivariate analysis the odds ratio of VTE for prolonged seated immobility at work was 1.8 (95% CI 0.71-4.8). The maximum number of hours seated at work was associated with VTE, with the risk increasing by 10% per hour longer seated (odds ratio 1.1, 95% CI 1.0-1.2). The maximum number of hours seated at work without getting up was associated with VTE, with the risk increasing by 20% per hour longer seated (odds ratio 1.2, 95% CI 0.96-1.6). This study provides preliminary evidence that prolonged seated immobility at work may represent a risk factor for VTE.

In-Hospital and Follow-Up Clinical Outcomes of Percutaneous Coronary Intervention (PCI) in Octogenarians at Wellington Hospital

Background: Previous studies of clinical outcomes of PCI in the elderly patients demonstrated increase in-hospital mortality. As the number of patients in this age group presenting with acute coronary syndromes continues to increase, the in-hospital and follow-up experience of a tertiary centre is of interest.

In-Hospital and Follow-Upclinical Outcomes of Percutaneous Coronary Intervention (PCI) in Octogenarians at Wellington Hospital

Background: Previous studies of clinical outcomes of PCI in the elderly patients demonstrated increase in-hospital mortality. As the number of patients in this age group presenting with acute coronary syndromes continues to increase, the in-hospital and follow-up experience of a tertiary centre is of interest.

Nuclear cardiology

<b>Avijit Lahiri</b> is consultant cardiologist and director of cardiac imaging and research, Wellington Hospital, London <b>Nik Sabharwal</b> is specialist registrar in cardiology with an interest in cardiac imaging at the John Radcliffe Hospital, Oxford

Delay in radiotherapy shortens survival in patients with high grade glioma

Fractionated external beam radiotherapy is an important component of standard treatment for high grade glioma. Due to resource constraints, patients may experience delays in receiving treatment. The purpose of this study was to evaluate the effect of radiotherapy waiting time on survival in patients with high grade glioma. A retrospective analysis was performed of 172 patients with a histological diagnosis of WHO Grade 3 or 4 Astrocytoma who had undergone surgery at Wellington Hospital between 1993 and 2003, and who subsequently underwent radiotherapy. Time to radiotherapy after surgery varied from 7 days to over 16 weeks. Multiple Cox regression analysis showed that age, performance status, tumour grade, extent of surgical resection, radiotherapy dose, and time to radiotherapy from day of surgery were all independently related to survival. Every additional week of delay until the start of radiotherapy increases the risk of death (hazard ratio) by 8.9% (95%CI 2.0%-16.1%). A 6 week delay in starting radiotherapy (from 2 weeks post-op to 8 weeks) reduces median survival by 11 weeks for a typical patient. Delay in radiotherapy results in a clinically significant reduction in survival. These findings have implications for resource allocation and for the design of clinical trials.

CT02 A STUDY TO EVALUATE VARIOUS TECHNIQUES OF CORONARY ARTERY BYPASS GRAFTING

Introduction In Wellington Hospital, CABG is being performed by various techniques like OPCAB, On‐pump cardioplegic arrest, fibrillatory arrest and On‐pump beating heart.Aim This study was undertaken to compare morbidity and mortality between On‐ pump CABG and OPCAB on basis of Euroscore.Material and Method From January 2003 till December 2004, data were collected according to Australasian society of Cardiothoracic surgery data set. Euroscores were calculated and patients were divided into 3 groups. Results of OPCAB and On‐pump CABG were compared on basis of Euroscore group. In this period we performed 350 On‐pump CABG and 254 OPCAB.Results OPCAB group had less number of grafts per patients. Even for triple vessel disease numbers of grafts were lower in OPCAB group. OPCAB group had more patients with total arterial revascularization. There were 10 deaths in On‐pump group and 1 in OPCAB group. In the low and moderate risk group there was no significant difference in hospital stay, ventilation hours and ICU stay. However inotropic requirement and requirements of blood products were less in OPCAB group. There was no statistically significant difference between Incidence of new renal failure or arrhythmia in two groups. 2 patients in each group had blocked graft in immediate postop period and required revascularization. There were only 5 patients in the high‐risk group in OPCAB making intergroup comparisons difficult.Conclusion OPCAB does not offer any significant advantage in terms of mortality and morbidity over On‐pump CABG. To evaluate the effects of number of grafts and total arterial revascularization, it needs a long‐term follow‐up.

PATIENTS WITH METASTATIC CANCER OF UNKNOWN PRIMARY SITE: DIAGNOSTIC WORKUP AND THERAPEUTIC MANAGEMENT

PATIENTS WITH METASTATIC CANCER OF UNKNOWN PRIMARY SITE: DIAGNOSTIC WORKUP AND THERAPEUTIC MANAGEMENT Majeed H Alwan FRCS, FACS, Gastrointestinal and General Surgeon, Wellington Hospital, Wellington, New Zealand Abstract Metastatic Cancer of Unknown Primary site (CUP) accounts for about 4% of all cancer patients and is therefore one of the 10 most frequent cancer diagnoses in man. It is defined as biopsy-confirmed malignancy for which the site of origin is not identified by routine workup. It is believed that CUP represents a heterogeneous group of malignancies that have a presumably, specific biology with clinical characteristics of rapid progression and random atypical metastases. The diagnostic work-up could be variable. Certain clinicopathological CUP entities are considered as favorable subsets responding to systemic platinum-based chemotherapy or managed by locoregional treatment. These subsets have a better prognosis than the average median survival time of four months in patients who belong to the non-favorable subsets.

Mifepristone‐ and misoprostol‐induced mid‐trimester termination of pregnancy: A review of 272 cases

Mifepristone became available in New Zealand in 2001, and was first used for second trimester terminations at the Level J Unit, Wellington Hospital. The protocol is based on that published by Ashok et al. in Aberdeen. To describe the use of mifepristone prior to misoprostol induction of labour for mid-trimester termination and to compare outcomes with the published data. A retrospective audit of prospectively collected notes for 272 women presenting for mid-trimester termination of pregnancy in a hospital termination clinic. Data collection included age, ethnicity, previous pregnancies, gestational age, induction-to-abortion interval, analgesia, and complications. Data were entered into an Access database and imported into Excel and Epi Info for the computation of descriptive statistics. Data on completed abortion were available for 271 women (one chose not to continue the abortion following mifepristone). The median time to abortion was 6 h, and mean number of doses of misoprostol was three. The proportion of women who aborted within 24 h was 95.9%. Immediate surgical evacuation of retained placenta was required in 22 women (8.1%). Heavy bleeding occurred in 22 women (8.1%), and seven required a transfusion (2.6%). The proportion of women who required parenteral narcotics was 78.2%. Outcomes for women in the present review were comparable with those for previous publications using the same regimen, with the exception of a higher transfusion rate. Our experience supports the finding that the use of mifepristone as pretreatment to misoprostol results in a shorter induction-to-delivery interval than the use of misoprostol alone as has been reported by other groups.

The colloid adenocarcinomata of the bladder valut arising from the epithelium of the urachal canal: With a critical survey of the tumours of the urachus

Journal Article The colloid adenocarcinomata of the bladder valut arising from the epithelium of the urachal canal: With a critical survey of the tumours of the urachus Get access R Campbell Begg R Campbell Begg Genito-Urinary Surgeon Wellington Hospital, N.Z. Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 18, Issue 71, January 1931, Pages 422–466, https://doi.org/10.1002/bjs.1800187108 Published: 06 December 2005

Review of positive direct antiglobulin tests found on cord blood sampling

Until recently, all babies born in Wellington had umbilical cord blood sampling for direct antiglobulin test (DAT). It is considered to be an important test in identifying babies who are at risk of haemolytic disease of the newborn (HDN). The aim of this review was to examine the utility of positive DAT results and ascertain: -- How many cases required phototherapy? -- Were any babies readmitted for phototherapy? -- Did the positive DAT influence the detection and treatment of HDN? The clinical records of all newborn babies found to have positive DATs by Wellington Hospital Blood Bank, over a 6-month period (January 2001-June 2001) were reviewed. Blood group serological results of all babies that received phototherapy during this period were also reviewed. Ninety-four babies had a positive DAT, of which 22 (23%) received phototherapy. The incidence of a positive cord blood DAT was found to be 5.5%. In total, 1724 cord blood samples were analysed by Blood Bank over the first 6 months in 2001. Overall 145 babies received phototherapy, 117 were DAT-negative and six were not tested. Six of the 22 (27%) DAT-positive babies that received phototherapy were alerted by a positive DAT, leading to measurement of serum bilirubin (SBR). Twelve of the 22 (55%) were initially alerted by clinical jaundice, leading to measurement of SBR. Two DAT-positive cases were diagnosed antenatally, both were due to anti-D. Overall 10 babies were readmitted for phototherapy, two had a positive DAT. One baby received an exchange transfusion in addition to phototherapy. Two babies that received phototherapy had SBRs in the exchange transfusion range. Eighty-six per cent of the DAT-positive cases treated with phototherapy were due to anti-A. There were four cases of DAT-negative ABO HDN. The positive predictive value of a positive DAT for HDN is 23%. The sensitivity was estimated to be 86%. Ten babies required readmission for phototherapy, two of these were DAT-positive. Jaundice, rather than the positive DAT, was the first alert in the majority of cases of HDN requiring phototherapy. Recommendations for testing are discussed but remain controversial in practice. Assessment for hyperbilirubinaemia in all infants early in life is fundamental.

Introduction of early medical abortion in New Zealand: An audit of the first 67 cases

In New Zealand, mifepristone became available in 2001, but because of uncertainty about the law, the first 67 cases were carried out under a very strict protocol. Once the prostaglandin had been administered it was necessary that the woman remain in the unit until the products of conception (POC) had been passed and, if this had not occurred within 8 h, she underwent suction curettage. To demonstrate that an early medical termination of pregnancy (EMTOP) service could be offered as a safe option for women, despite the constraints of the law. An audit of patient notes was carried out on the first 67 patients undergoing an EMTOP at the Level J Unit (LJU), Wellington Hospital. Data collected included age, ethnicity, parity, previous abortions, gestational age, length of time between the administration of mifepristone and misoprostol, length of time after administration of misoprostol to the completion of abortion, whether a fetal sac was seen, analgesia required, extent of heavy bleeding and any adverse effects. Patient characteristics were compared with those of the 3052 women who underwent surgical termination during the same time period. Data were analysed using EpiInfo 2000 (Centers for Disease Control and Prevention, Atlanta, GA) and Chi square tests for significance. Successful completion of EMTOP occurred in 63 of 67 cases (94%). Only four cases (6%) required completion by suction curettage and this was performed for legal and financial reasons, rather than for medical reasons. Clinical events requiring management, mainly bleeding problems, occurred in 11 patients (16%). EMTOP with mifepristone and misoprostol was successfully introduced and the experience provides useful data for others contemplating a similar service.

Fine‐needle aspiration cytodiagnosis of nipple adenoma (papillomatosis) in a man and woman

Diagnostic CytopathologyVolume 31, Issue 6 p. 432-433 Letters to the Editor Fine-needle aspiration cytodiagnosis of nipple adenoma (papillomatosis) in a man and woman Raj K. Gupta M.D., F.I.A.C., Corresponding Author Raj K. Gupta M.D., F.I.A.C. raj.gupta@xtra.co.nz Wellington Hospital and Valley Diagnostic Laboratory, Ltd., Lower Hutt, New ZealandValley Diagnostic Laboratory, Ltd., 22-Kings Crescent, P.O. Box 30-044, Lower Hutt, New ZealandSearch for more papers by this authorCarl S. Dowle M.B., Ch.B., F.R.C.S., F.R.A.C.S.,, Carl S. Dowle M.B., Ch.B., F.R.C.S., F.R.A.C.S., Hutt and Wellington Hospital, Lower Hutt, New ZealandSearch for more papers by this authorSarla Naran B.Sc., C.F.I.A.C., Sarla Naran B.Sc., C.F.I.A.C. The Cytology Unit, Wellington Hospital, Wellington, New ZealandSearch for more papers by this authorSharda Lallu B.Sc., C.F.I.A.C., Sharda Lallu B.Sc., C.F.I.A.C. The Cytology Unit, Wellington Hospital, Wellington, New ZealandSearch for more papers by this author Raj K. Gupta M.D., F.I.A.C., Corresponding Author Raj K. Gupta M.D., F.I.A.C. raj.gupta@xtra.co.nz Wellington Hospital and Valley Diagnostic Laboratory, Ltd., Lower Hutt, New ZealandValley Diagnostic Laboratory, Ltd., 22-Kings Crescent, P.O. Box 30-044, Lower Hutt, New ZealandSearch for more papers by this authorCarl S. Dowle M.B., Ch.B., F.R.C.S., F.R.A.C.S.,, Carl S. Dowle M.B., Ch.B., F.R.C.S., F.R.A.C.S., Hutt and Wellington Hospital, Lower Hutt, New ZealandSearch for more papers by this authorSarla Naran B.Sc., C.F.I.A.C., Sarla Naran B.Sc., C.F.I.A.C. The Cytology Unit, Wellington Hospital, Wellington, New ZealandSearch for more papers by this authorSharda Lallu B.Sc., C.F.I.A.C., Sharda Lallu B.Sc., C.F.I.A.C. The Cytology Unit, Wellington Hospital, Wellington, New ZealandSearch for more papers by this author First published: 11 November 2004 https://doi.org/10.1002/dc.20168Citations: 5AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume31, Issue6December 2004Pages 432-433 RelatedInformation

Magnesium.

Emergency MedicineVolume 15, Issue 1 p. 92-96 Magnesium Craig Wallace, Corresponding Author Craig Wallace Emergency Department, Wellington Hospital, Wellington, New ZealandDr Craig Wallace, Emergency Medicine Registrar, Wellington Hospital, Private Bag 7902 Riddiford, Wellington, New Zealand. Email: craig_wallace@bigfoot.comSearch for more papers by this author Craig Wallace, Corresponding Author Craig Wallace Emergency Department, Wellington Hospital, Wellington, New ZealandDr Craig Wallace, Emergency Medicine Registrar, Wellington Hospital, Private Bag 7902 Riddiford, Wellington, New Zealand. Email: craig_wallace@bigfoot.comSearch for more papers by this author First published: 06 February 2003 https://doi.org/10.1046/j.1442-2026.2003.00417.xCitations: 5 Craig Wallace, MBBS, FACEM, Emergency Medicine Registrar. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume15, Issue1February 2003Pages 92-96 RelatedInformation

Factor V Leiden deficiency?

Acta PaediatricaVolume 91, Issue 10 p. 1143-1143 Factor V Leiden deficiency? K McFadden, Corresponding Author K McFaddenK McFadden, Department of Obstetrics Gynaecology, Wellington Hospital, Private Bag 7902, Wellington South, New Zealand (Tel. +64 4 385 5999, e-mail. Kim.luke@paradise.net.nz)Search for more papers by this author K McFadden, Corresponding Author K McFaddenK McFadden, Department of Obstetrics Gynaecology, Wellington Hospital, Private Bag 7902, Wellington South, New Zealand (Tel. +64 4 385 5999, e-mail. Kim.luke@paradise.net.nz)Search for more papers by this author First published: 02 January 2007 https://doi.org/10.1111/j.1651-2227.2002.tb00116.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume91, Issue10October 2002Pages 1143-1143 RelatedInformation

Sleep disorders: a potential role in New Zealand motor vehicle accidents.

The potential role of sleep disorders in New Zealand motor vehicle accidents (MVA) has not been systematically studied. To trial a recruitment method and document the frequency of sleep disorders in drivers attending an emergency department with injury following MVA. Injured drivers admitted to Wellington Hospital Emergency Department were prospectively recruited by letter and follow-up telephone call. Data from a traffic accident, health and sleep questionnaire and polysomnography were collected and analysed using the SPSS statistical package. Of 120 eligible drivers, 40 (33%) completed the study protocol. The mean age of participants was 44 +/- 17 years. Non-participants were younger (mean age 33 +/- 14 years, P < 0.01) and more often of Asian or Pacific Island ethnicity (P < 0.01). Twenty-seven (67%) felt unrefreshed on waking and 10 (25%) had an elevated Epworth Sleepiness Score (> 10/24). Six (15%) felt drowsy or fell asleep prior to the accident. Sleep disorders were common (40%): obstructive sleep apnoea 14 (35.9%), periodic limb movements of sleep three (7.7%), sleep restriction (< 6 h sleep on a regular basis) five (12.5%), and insomnia one (2.5%). Daytime somnolence and sleep disorders were commonly found in drivers attending the Emergency Department after accidents resulting in injury. Driver fatigue and sleep disorders should be considered as a potential contributing factor in New Zealand MVAs. Recruitment of drivers following a MVA via the Emergency Department is challenging. Strategies to improve recruitment are discussed.

Proximal femoral osteotomy for the treatment of hip arthritis in young adults.

The outcome of proximal femoral osteotomy for hip arthritis in young adults performed at the Wellington Hospital (Wellington, New Zealand) was reviewed. Seventeen patients underwent 21 proximal femoral osteotomies for the treatment of hip arthritis at Wellington Hospital between 1992 and 1999. Thirteen patients (17 hips) were contacted and were able to complete a questionnaire form specific for hip pain and function. There was a response rate of 76.5% (13 out of a possible 17 patients undergoing proximal femoral osteotomy) at a mean 3 years 4 months postoperatively. Of these, one patient has had a total hip joint replacement and one patient is currently on the waiting list for a total hip joint replacement. Three other patients (three hips) report moderate or severe hip pain. The remaining eight patients (12 hips) report having mild or no hip pain. Questionnaire results show a postoperative decrease in hip pain in most patients. Hip function as assessed by the questionnaire was essentially unchanged. Proximal femoral osteotomy is a satisfactory option for young patients with degenerative hip arthritis. The operation is only likely to be useful in the treatment of pain.

BAHT Education Subcommittee Offer Their Congratulations to all Who Passed the Level I Course at the Wellington Hospital, London

BAHT Education Subcommittee Offer Their Congratulations to all Who Passed the Level I Course at the Wellington Hospital, London

Glasgow Coma Scale: variation in mortality among permutations of specific total scores.

The objective of this study was to determine whether different score permutations of the Glasgow Coma Scale (GCS) giving the same GCS total score were associated with significantly different mortality. For each GCS total we compared the mortality associated with each of the different GCS permutations using a Fisher's exact test. The relationship between components of the GCS score and mortality was also examined using uni- and multivariate logistic regression. Data were collected from the intensive care unit at Wellington Hospital, a multidisciplinary, tertiary referral unit. We analysed the GCS and mortality data from all admissions over a 4 year period (January 1994-January 1998). Patients with GCS scores of 3 or 15 were excluded, since these two total scores do not have multiple permutations, leaving 1,390 patients with GCS scores of 4-14 for analysis. The incidence of mortality was significantly different for the different permutations for total GCS scores of 7, 9, 11 and 14. It is possible for patients to have the same total GCS score, but significantly different risks of mortality due to differences in the GCS profile making up that score. This suggests that GCS scores may be more useful reported in terms of profiles rather than totals. This could also have implications for the use of other scoring systems such as Acute Physiology and Chronic Health Evaluation and Simplified Acute Physiology Score.