Zealand Guidelines Research Articles

Sediment Metal Concentration Survey Along the Mine-Affected Molonglo River, NSW, Australia

Metal concentrations were measured in sediments of the mine-affected Molonglo River to determine current metal concentrations and distribution along the river. Compared with an uncontaminated site at 6.5 km upstream of the Captains Flat mine, sediments collected from the river at ≤12.5 km distance below the mine had a significantly higher percentage of finely divided silt and clay with higher concentrations of cadmium (Cd), copper (Cu), lead (Pb), and zinc (Zn). The measured metal concentrations in the mine affected sites of the river were in the following order: Zn = 697-6818 > Pb = 23-1796 > Cu = 10-628 > Cd = 0.13-8.7 µg/g dry mass. The highest recorded metal concentrations were Cd at 48, Cu at 45, Pb at 240, and Zn at 81 times higher than the background concentrations of these metals in the river sediments. A clear sediment metal-contamination gradient from the mine site to 63 km downstream was established for Cd, Cu, Pb, and Zn in the river sediments. Compared with sediment metal concentrations before a major flood in 2010, only Zn concentrations increased. For all of the mine-affected sites studied, Cd and Zn concentrations exceeded the (ANZECC/ARMCANZ, Australian and New Zealand guidelines for fresh and marine water quality. Australian and New Zealand Environment and Conservation Council/Agriculture and Resource Management Council of Australia and New Zealand, 2000) interim sediment-quality guidelines low values for Cd (1.5 µg/g dry mass) and the high value for Zn (410 µg/g dry mass). Existing metal loads in the riverbed sediments may still be adversely affecting the river infauna.

International sore throat guidelines and international medical graduates: a mixed methods systematic review.

AIM To examine national and international guidelines on sore throat management and subsequently, to explore the phenomenon of international medical graduates working in general and rural practice in New Zealand. METHOD Two separate systematic reviews were conducted that resulted in a contingent methodology. Contingent methodologies involve syntheses of data that are derived sequentially. The initial review for this study examined international sore throat guidelines and their key points. The results of this initial review resulted in the theory that international medical graduates may be unaware of the New Zealand specific sore throat guidelines and the problem of acute rheumatic fever in this country. The subsequent review examined the phenomenon of international medical graduates working in general or rural practice in New Zealand. Data sources were Medline, Google Scholar, Trip Database, and NHS Evidence, Embase and Scopus. Electronic databases were searched for relevant data published January 2000-December 2013. Additional hand searches found key references from articles and websites. RESULTS International guidelines for the management of sore throats differ from New Zealand guidelines. Of resource rich countries, New Zealand has the second highest number of international medical graduates: they may not use New Zealand specific sore throat guidelines. DISCUSSION Acute rheumatic fever is virtually eradicated in most resource rich countries. Rheumatic fever rates of among indigenous Māori and Pacifika people in New Zealand have failed to reduce over the last three decades. Knowledge and actions of international medical graduates in relation to sore throat management needs investigating. KEYWORDS Sore throats; acute rheumatic fever; clinical guidelines; international medical graduates; mixed methods review.

Sunscreen compliance with regional clinical practice guidelines and product labeling standards in New Zealand.

INTRODUCTION For general practitioners, practice nurses and community pharmacists in New Zealand, a core duty is to educate patients about sun protection. We aimed to evaluate compliance of locally available sunscreens with regional clinical practice guidelines and sunscreen labelling standards, to assist clinicians in advising consumers on sunscreen selection. METHODS We audited all sunscreens available at two Auckland stores for three New Zealand sunscreen retailers. We then assessed compliance with accepted regional clinical practice guidelines for sun protection from the New Zealand Guidelines Group. We further assessed compliance with regional Australia/New Zealand consumer standards for sunscreen labelling. RESULTS All sunscreens satisfied clinical guidelines for broad-spectrum protection, and 99% of sunscreens met or exceeded clinical guidelines for minimal Sun Protection Factor. Compliance with regional standardized labelling guidelines is voluntary in New Zealand and 27% of audited sunscreens were not fully compliant with SPF labelling standards. DISCUSSION Sunscreens were generally compliant with clinical guidelines for minimal sun protection. However there was substantial noncompliance with regional recommendations for standardized sunscreen labelling. Primary health care clinicians should be aware that this labelling noncompliance may mislead patients into thinking some sunscreens offer more sun protection than they do. Mandatory compliance with the latest regional labelling standards would simplify sunscreen selection by New Zealand consumers. KEYWORDS Sunscreen; Sun Protection Factor; SPF; Skin Neoplasms; Melanoma; Skin Cancer Prevention.

Duty of care following stroke: Family experiences in the first six months

Introduction and BackgroundStroke is the third largest cause of death in New Zealand and is a major cause of disability. An estimated 45,000 people live with a stroke in New Zealand and around 70% are dependent on others to help with their daily activities (Stroke Foundation of New Zealand, 2014; Stroke Foundation of New Zealand and New Zealand Guidelines Group, 2010). While a lot is known about the impact of stroke on the survivor and the primary caregiver little is known about how stroke affects the wider family. Impacts such as financial difficulties, strain and isolation have been seen as significant factors on the primary caregivers' experience (Bulley, Shiels, Wilkie, & Salisbury, 2010; Greenwood, Mackenzie, Cloud, & Wilson, 2009; Lutz, Young, Cox, Martz, & Creasy, 2011). The importance of family in stroke recovery was noted by Vincent et al. (2007) and Brunborg and Ytrehus (2014) who described how important family, friends and other social networks were to the stroke survivor's rehabilitation and well-being.In the New Zealand context Dyall, Feigin, and Brown (2008) and Corbett, Francis, and Chapman (2006) focused their studies on Maori stroke survivors and their caregivers. Dyall et al. (2008), using statistics from Feigin et al. (2006), argued there is greater health disparity and financial impact for Maori whanau than non-Maori families, as Maori have strokes at younger ages; 62 years for Maori compared to 75 years for Europeans.This study is part of a larger longitudinal hermeneutic project (2011-2015) undertaken by researchers from the Department of Nursing, Unitec Institute of Technology and the Waitemata District Health Board, Auckland, New Zealand.Research DesignAimThe aim of this study was to investigate the phenomenon of becoming and being a family member of a stroke survivor over the period of six months after the initial stroke.MethodologyThis was an exploratory study using hermeneutic phenomenological research methodology.Flermeneutic phenomenology aims to understand the significance of practical activities and experiences in everyday lives and is well suited to studying human issues and concerns (Plager, 1994) such as family experiences post-stroke. The processes used in the study were guided by those described by van Manen (1997).MethodsParticipants for the study were recruited from the larger longitudinal project (Northern X Regional Ethics Committee: NTX/11/EXP/062/AM02) using purposive sampling strategies. Inclusion criteria were: (1) family of a person admitted to the Assessment, Treatment and Rehabilitation (ATR) ward following a first-ever stroke where at least two family members agreed to participate; (2) adequate spoken English to complete consent and the interview. Informed consent was obtained in writing at the beginning of the project and on-going verbal consent obtained before each subsequent data collection phase. Consistent with the longitudinal project, 'family' was defined broadly to include people who live in close relationship with the stroke survivor. Five families who met inclusion criteria were recruited by intermediaries for the longitudinal project (total participants = 14), with one of these families consenting to participate in this study. This family were recruited as the stroke event coincided with the first author's availability to complete the study. The family included the spouse of a stroke survivor (Ivy) and two other family members (Deb and Jane). All of the participants were health professionals. To maintain anonymity their specific disciplines are not disclosed and other identifying data excluded. All data were anonymised and stored in password protected digital format only accessible to the research team. Pseudonyms were chosen by the researcher and are used throughout.Data collectionFace-to-face, semi-structured interviews were undertaken at six weeks, three and six months poststroke (December 2011 - May 2012). …

Thoracic Society of Australia and New Zealand oxygen guidelines for acute oxygen use in adults: 'Swimming between the flags'.

The purpose of the Thoracic Society of Australia and New Zealand guidelines is to provide simple, practical evidence-based recommendations for the acute use of oxygen in adults in clinical practice. The intended users are all health professionals responsible for the administration and/or monitoring of oxygen therapy in the management of acute medical patients in the community and hospital settings (excluding perioperative and intensive care patients), those responsible for the training of such health professionals, and both public and private health care organizations that deliver oxygen therapy.

Utility of Routine Exercise Stress Testing among Intermediate Risk Chest Pain Patients Attending an Emergency Department

To assess the utility of routine exercise stress testing (EST) in patients at intermediate risk of acute coronary syndrome (ACS) according to the Heart Foundation of Australia/Cardiac Society of Australia and New Zealand (HFA/CSANZ) guidelines. Prospective observational study of patients presenting to the Emergency Department (ED) with chest pain suggestive of ACS between November 2008 and July 2014. Participants included 1205 patients who presented to the ED with chest pain suggestive of ACS and who met the HFA/CSANZ intermediate risk criteria. The outcome was diagnosis of ACS occurring on presentation or within 30 days of presentation to the ED. ACS included acute myocardial infarction and unstable angina pectoris. Twenty (1.66%) of the intermediate risk patients were diagnosed with ACS. Of the 777 patients who underwent EST, eight had ACS. EST identified all ACS cases except for one patient with a negative test, who was ultimately diagnosed with ACS following angiography. 164 patients deemed inappropriate to undergo EST underwent an alternative form of objective testing, of which 12 were positive for ACS. 264 patients underwent no objective testing. EST stratifies intermediate risk patients to a near zero short-term risk of ACS. However, the overall yield of EST within this group of patients is extremely low. Intermediate risk patients with normal zero and six hour biomarkers have a very low probability of ACS, and over half of these patients ultimately diagnosed with ACS in this group were deemed unsuitable for EST anyway. Future research should focus on the identification of patients who do not require EST and the inclusion of routine EST within the HFA/CSANZ guidelines should be reconsidered.

Cost and outcomes of assessing patients with chest pain in an Australian emergency department.

We sought to characterise the demographics, length of admission, final diagnoses, long-term outcome and costs associated with the population who presented to an Australian emergency department (ED) with symptoms of possible acute coronary syndrome (ACS). Prospectively collected data on ED patients presenting with suspected ACS between November 2008 and February 2011 was used, including data on presentation and at 30 days after presentation. Information on patient disposition, length of stay and costs incurred was extracted from hospital administration records. Primary outcomes were mean and median cost and length of hospital stay. Secondary outcomes were diagnosis of ACS, other cardiovascular conditions or non-cardiovascular conditions within 30 days of presentation. An ACS was diagnosed in 103 (11.1%) of the 926 patients recruited. 193 patients (20.8%) were diagnosed with other cardiovascular-related conditions and 622 patients (67.2%) had non-cardiac-related chest pain. ACS events occurred in 0 and 11 (1.9%) of the low-risk and intermediate-risk groups, respectively. Ninety-two (28.0%) of the 329 high-risk patients had an ACS event. Patients with a proven ACS, high-grade atrioventricular block, pulmonary embolism and other respiratory conditions had the longest length of stay. The mean cost was highest in the ACS group ($13509; 95% CI, $11794-$15223) followed by other cardiovascular conditions ($7283; 95% CI, $6152-$8415) and non-cardiovascular conditions ($3331; 95% CI, $2976-$3685). Most ED patients with symptoms of possible ACS do not have a cardiac cause for their presentation. The current guideline-based process of assessment is lengthy, costly and consumes significant resources. Investigation of strategies to shorten this process or reduce the need for objective cardiac testing in patients at intermediate risk according to the National Heart Foundation and Cardiac Society of Australia and New Zealand guideline is required.

Chronic suppurative lung disease and bronchiectasis in children and adults in Australia and New Zealand Thoracic Society of Australia and New Zealand guidelines.

Guidelines on managing chronic suppurative lung disease (CSLD) and bronchiectasis (unrelated to cystic fibrosis [CF]) in Australian Indigenous children initiated in 20021 were extended to include Indigenous adults in 20082 and children and adults living in urban areas of Australia and New Zealand in 2010.3 Here, we present an updated guideline relevant for all sections of the community. The recommendations in this guideline are targeted principally to primary and secondary care, and are not intended for individualised specialist care. As with all guidelines, they are not a substitute for sound clinical judgement, particularly when investigating and treating such a phenotypically heterogeneous condition as bronchiectasis.4

Consultation on scope determination in the development of the National Heart Foundation Of Australia (NHFA) / Cardiac Society of Australia and New Zealand (CSANZ) guidelines for the management of acute coronary syndromes 2015

Consultation on scope determination in the development of the National Heart Foundation Of Australia (NHFA) / Cardiac Society of Australia and New Zealand (CSANZ) guidelines for the management of acute coronary syndromes 2015

Management and Characteristics of Patients with Metastatic Prostate Cancer in a Cohort of New Zealand Men

Objective: This study aims to (1) characterise men diagnosed with metastatic prostate cancer, (2) describe their management and (3) look at their survival. Methods: We identified patients registered with prostate cancer in the New Zealand Cancer Registry in the Midland Cancer Network region in 2009-2012 and examined these patients' clinical records to identify the metastatic cases. We investigated the patients' characteristics and the treatment pattern. All-cause survival was estimated by the Cox proportional hazards model. Results: Of the 2,127 men diagnosed with prostate cancer, 234 (26 Maori/Pacific and 208 non-Maori/non-Pacific) were diagnosed with metastatic prostate cancer. After the diagnosis, 194 (82.9%) patients received androgen deprivation therapy (ADT), 5 had chemotherapy and 104 (44.4%) had radiotherapy. Of the patients treated with ADT, 46 (23.7%) had no monitoring prostate-specific antigen tests. Fifty-nine percent of the patients were alive after 12 months and 35% after 24 months. The hazard ratio for the Maori/Pacific men was 1.49. Conclusion: Overall, the survival of patients with metastatic prostate cancer was poor. There seems to be a strong case for the development of New Zealand guidelines on the management of metastatic disease including the use of first-line treatments, the ongoing monitoring for the development of castration-resistant prostate cancer (CRPC) and the treatment of CRPC. © 2014 S. Karger AG, Basel

Provision of effective, meaningful and appropriate care for families who have experienced stillbirth: a comprehensive systematic review protocol

REVIEW OBJECTIVE The objective of this review is to identify effective, meaningful and/or appropriate non-pharmacological, psychosocial supportive care interventions and strategies for families to improve their psychological well-being following stillbirth. REVIEW QUESTIONS Review question 1 What are effective interventions and strategies for improving the psychological wellbeing of families who have experienced stillbirth? Review question 2 What are family’s experiences of interventions and strategies aimed at improving their psychological well-being following stillbirth? Specifically, this question examines the meaningfulness of interventions and strategies experienced by parents and families following stillbirth. Review question 3 What is the appropriateness of interventions and strategies aimed at improving the psychological well-being of families who have experienced stillbirth? Specifically, this question examines the cultural appropriateness of interventions following stillbirth. INCLUSION CRITERIA Participants The participants of interest for the review will be families who have experienced stillbirth. In this review, family is defined as mothers and/or fathers and/or siblings who have experienced stillbirth. Siblings are defined as the siblings of the stillborn baby. Studies that include parents or families who have experienced neonatal death, perinatal death (before or after birth), miscarriage, termination of pregnancy for non-medical or genetic reasons or pregnancy loss prior to 20 weeks will be excluded. Studies that include parents or families who have experienced neonatal death, perinatal death (before or after birth), miscarriage, termination of pregnancy for non-medical or genetic reasons or pregnancy loss prior to 20 weeks as well as stillbirth will be excluded if patient data relating to TRUNCATED AT 250 WORDS

Acute coronary syndrome in Australia: Where are we now and where

Acute coronary syndrome (ACS) is a significant contributor to both morbidity and mortality in Australia. Generally speaking, sufferers of ACS who live in rural areas and are treated at rural hospitals have poorer outcomes than those living in metropolitan areas. To characterise the differences in the management and outcomes of rural and metropolitan populations in the context of ACS, as well as identify factors responsible for these differences and suggest how they may be addressed. A review of the current literature surrounding ACS in Australia was undertaken. Through the MEDLINE/PubMed database a thorough search using the terms "acute coronary syndrome" and "Australia" identified 460 papers for review, excluding abstracts and adding "rural", "metropolitan", "reperfusion", and "outcomes" to this search narrowed the results to 149 papers for review. Data was also extracted from the Australian Institute of Health and Welfare and other Australian government publications. The review draws on insights from both local and international resources and seeks to provide an understanding of the contemporary landscape of ACS in both rural and metropolitan Australia. The review is broken down into three key sections: An outline of the 2011 National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand (NHF/CSANZ) guidelines and adjuvant tools used in the assessment and treatment of ACS, and to what extent these guidelines have been implemented clinically.An exploration of the current landscape of ACS in Australia and identification of the disparities facing rural populations compared to those in metropolitan areas.Discussion of the factors that are resulting in poorer outcomes for ACS sufferers and suggestions of novel approaches towards addressing these factors. Disparities exist between the management and outcomes of rural and metropolitan populations experiencing ACS. While the causes of these discrepancies are multifactorial; the onus is on the healthcare system to effectively reduce associated morbidity and mortality. Improvements in the management of ACS may be achieved through a continued reduction in call-to-needles time via the use of remote and mobile thrombolysis services as well as improvements in in-hospital risk assessment in order to flag and investigate those at risk of ACS.

Development of New Fatigue Model for New Zealand Dense Graded Hot Mix Asphalts

The Mechanistic empirical pavement design method for flexible pavements is based on modelling certain modes of failures for different pavement materials. In the Australian and New Zealand guidelines, the mechanistic empirical pavement design is based on modelling fatigue and permanent deformation as the two major modes of failures. The Austroads guidelines use the Shell fatigue performance transfer function to model the fatigue behaviour of asphalt mixes. In this research, the fatigue behaviour of different mixes AC10, AC14 and AC20 with different types of binders 80/100 and 60/70 was thoroughly investigated. The Shell model significantly underestimated the measured fatigue life for all mixes. A wide range of properties of the examined mixes was considered; percent of air voids ranges from 1.2% to 11.4%, binder content (at optimum, ± 0.5 from optimum), and the flexural modulus ranges from 1600 to 4576 MPa. A new fatigue model was developed at the University of Canterbury. The Canterbury model was based on the bending beam fatigue results of 78 beams tested at constant strain mode at different strain levels range from 300 to 600 microstrains. The new model provides a much better matching to the measured data with no observed bias and it accounts for percentage of air voids in the total mix and the effective binder content instead of the total binder content that is currently included in the Shell Model.

Human Health Risks of Geothermally Derived Metals and Other Contaminants in Wild-Caught Food

Arsenic (As) and mercury (Hg) associated with geothermally influenced lakes and rivers represent a potential health risk to communities where wild-caught food is consumed. The Rotorua Lakes region of New Zealand has extensive natural geothermal activity and a large proportion (35%) of indigenous Māori population, for whom wild food gathering is an important cultural activity. The aim of this study was to measure selected heavy metal and organochlorine (OC) concentrations in important local fish and shellfish species and assess the potential health risk to the local population of consuming these species. Following U.S. Environmental Protection Agency (EPA) protocols, consumption limits were calculated based on both excess lifetime cancer risk and noncancer risk. These were compared with local consumption rates, which were determined by questionnaire (n = 19). Median and 95th percentile contaminant concentrations were calculated to approximate random and most extreme contaminant consumption scenarios. Only Hg concentrations exceeded established Food Standards Australia New Zealand (FSANZ) guideline values of 0.5 mg/kg, namely, for rainbow trout (Oncorhynchus mykiss; 62% of the study sites) and koura (freshwater crayfish; Paranephrops planifrons; 25% of sites). The major risk was from consumption of trout, where the local consumption rate (1.5 meals/mo) exceeded the consumption limit of 0.9 meals/mo (median data) and 0.4 meals/mo (95th percentile data). Shellfish—pipi (Paphies australis) and mussel (Perna canaliculus)—collected from the only estuarine site also had local consumption rates (3.5 meals/mo) above calculated consumption limits (2.6 and 2.9 meals/mo, respectively). Our results, while based on a limited sample size and therefore exploratory in nature, nevertheless provide the basis for developing consumption guidelines. This study makes a significant contribution to broadening our understanding of the complexities of managing customary fisheries.

Subsequent axillary surgery after sentinel lymph node biopsy: Results from the BreastSurgANZ Quality Audit 2006–2010

ObjectivesTo use data from the BreastSurgANZ Quality Audit (BQA) to examine the patterns of completion axillary lymph node dissection (cALND) after sentinel lymph node (SLN) biopsy in women treated for early breast cancer in Australia and New Zealand and to compare it to the Australian and New Zealand guidelines in cases of both positive and negative SLN results. Materials and methodsPatients were sub grouped as having primary tumours ≤3 cm and >3 cm and further analysed according to year of surgery, SLN status and final nodal status where cALND was recorded. Multivariate analysis was performed examining tumour size, grade, presence of lymphovascular invasion (LVI), HER2 and oestrogen receptor status, patient age and number of positive sentinel nodes as predictors for subsequent axillary surgery. Results14879 patients were identified from 2006 to 2010. 79.8% of patients with a positive SLN result underwent cALND. Age >70 years and a greater number of involved SLN predicted no cALND among SLN positive patients. 10.3% of patients who had a negative SLN result underwent cALND. Younger age, higher grade, lymphovascular invasion and tumour size >3 cm predicted cALND among SLN negative patients. ConclusionsAccording to the BQA from 2006 to 2010 the Australian and New Zealand guideline recommendations for SLN positive patients to have cALND and SLN negative patients not to have cALND were adhered to in 79.8% and 89.7% of cases respectively.

Melanoma in primary care. The role of the general practitioner

The British Association of Dermatologists and the National Cancer Control Programme in Ireland discourage all GPs from biopsying any lesions suspicious of melanoma. The aim of this study was to assess whether or not it is safe and practical for a general practitioner with extra training in dermatology and skin surgery to assess suspicious skin lesions and treat low risk melanomas. The outcome of 56 new melanomas (31 invasive, 7 in situ and 18 lentigo maligna) in 53 patients, managed by a GP with extra training in dermatology and skin surgery, over a 20 year period, was examined. Forty-eight (86 %) of the melanomas had the initial biopsy carried out in primary care. The average time from presentation to the practice to the date of the biopsy was 8 days for the in situ and invasive melanomas and 17 days for the lentigo malignas. Twenty-eight (50 %) of the melanomas were considered low risk (in situ, invasive <1 mm deep or lentigo maligna) and were treated successfully in primary care according to the Australian and New Zealand guidelines, without any surgical complications. GPs with extra training in skin cancer and skin surgery could assess most suspicious skin lesions with dermoscopy and if necessary, biopsy most of these lesions in primary care. This would lead to a quicker diagnosis, more rapid pathway to definitive treatment, lower cost and more convenience to the patient, especially for those living in rural areas.

Site-specific water quality guidelines: 1. Derivation approaches based on physicochemical, ecotoxicological and ecological data

Generic water quality guidelines (WQGs) are developed by countries/regions as broad scale tools to assist with the protection of aquatic ecosystems from the impacts of toxicants. However, since generic WQGs cannot adequately account for the many environmental factors that may affect toxicity at a particular site, site-specific WQGs are often needed, especially for high environmental value ecosystems. The Australian and New Zealand Guidelines for Fresh and Marine Water Quality provide comprehensive guidance on methods for refining or deriving WQGs for site-specific purposes. This paper describes three such methods for deriving site-specific WQGs, namely: (1) using local reference water quality data, (2) using biological effects data from laboratory-based toxicity testing, and (3) using biological effects data from field surveys. Two case studies related to the assessment of impacts arising from mining operations in northern Australia are used to illustrate the application of these methods. Finally, the potential of several emerging methods designed to assess thresholds of ecological change from field data for deriving site-specific WQGs is discussed. Ideally, multiple lines of evidence approaches, integrating both laboratory and field data, are recommended for deriving site-specific WQGs.

Revisions to the derivation of the Australian and New Zealand guidelines for toxicants in fresh and marine waters

The Australian and New Zealand Guidelines for Fresh and Marine Water Quality are a key document in the Australian National Water Quality Management Strategy. These guidelines released in 2000 are currently being reviewed and updated. The revision is being co-ordinated by the Australian Department of Sustainability, Environment, Water, Population and Communities, while technical matters are dealt with by a series of Working Groups. The revision will be evolutionary in nature reflecting the latest scientific developments and a range of stakeholder desires. Key changes will be: increasing the types and sources of data that can be used; working collaboratively with industry to permit the use of commercial-in-confidence data; increasing the minimum data requirements; including a measure of the uncertainty of the trigger value; improving the software used to calculate trigger values; increasing the rigour of site-specific trigger values; improving the method for assessing the reliability of the trigger values; and providing guidance of measures of toxicity and toxicological endpoints that may, in the near future, be appropriate for trigger value derivation. These changes will markedly improve the number and quality of the trigger values that can be derived and will increase end-users’ ability to understand and implement the guidelines in a scientifically rigorous manner.

Compliance with Therapy as Recommended by the New Zealand and Australasian ACS Guideline in Tauranga Hospital

Results: In 51 ACS patients (median age 62 years, 69% male, 26% ST elevation) we observed a marked variation in GPx activity, with a 2.3 fold increase from the 10th to 90th percentile. We observed a significant correlation betweenGPxactivityandNO-mediatedplatelet inhibition (rho= 0.3, *p< 0.05), our surrogate marker for ROS. Conclusion: In an ACS population we observed considerable variation in GPx activity, and a correlation between GPx activity and an inverse marker of ROS. This supports our hypothesis that low levels of GPx activity will be associatedwith high levels of ROS. The clinical consequence of this relationship is the subject of on-going investigation. http://dx.doi.org/10.1016/j.hlc.2013.04.033

Cardiovascular Investigations of Airline Pilots with Excessive Cardiovascular Risk

This study examined the prevalence of airline pilots who have an excessive cardiovascular disease (CVD) risk score according to the New Zealand Guideline Group (NZGG) Framingham-based Risk Chart and describes their cardiovascular risk assessment and investigations. A cross-sectional study was performed among 856 pilots employed in an Oceania based airline. Pilots with elevated CVD risk that had been previously evaluated at various times over the previous 19 yr were reviewed retrospectively from the airline's medical records, and the subsequent cardiovascular investigations were then described. There were 30 (3.5%) pilots who were found to have 5-yr CVD risk score of 10-15% or higher. Of the 29 pilots who had complete cardiac investigations data, 26 pilots underwent exercise electrocardiography (ECG), 2 pilots progressed directly to coronary angiograms and 1 pilot with abnormal echocardiogram was not examined further. Of the 26 pilots, 7 had positive or borderline exercise tests, all of whom subsequently had angiograms. One patient with a negative exercise test also had a coronary angiogram. Of the 9 patients who had coronary angiograms as a consequence of screening, 5 had significant disease that required treatment and 4 had either trivial disease or normal coronary arteries. The current approach to investigate excessive cardiovascular risk in pilots relies heavily on exercise electrocardiograms as a diagnostic test, and may not be optimal either to detect disease or to protect pilots from unnecessary invasive procedures. A more comprehensive and accurate cardiac investigation algorithm to assess excessive CVD risk in pilots is required.