Celebration Week 2010
Abstracts for Poster Presentations
1
Contents
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
ESTABLISHMENT OF A NATIONAL FAMILIAL GASTROINTESTINAL CANCER REGISTRY: A
PRELUDE TO BOWEL CANCER SCREENING
MULTICOLOUR IMMUNO-FLUORESCENCE OF PARAFFIN EMBEDDED HODGKIN LYMPHOMA
LYMPH NODES
THE OUTCOME OF PATIENTS WITH DIFFUSE LARGE B CELL LYMPHOMA WHO PROGRESS
AFTER R-CHOP CHEMOTHERAPY
THE EXPERIENCE OF YOUNG PEOPLE WITH JIA TRANSFERRED FROM PAEDIATRIC TO ADULT
SERVICES
BREAST CANCER, ILLNESS PERCEPTIONS & ADHERENCE TO AROMATASE INHIBITORS
DOES NEW ZEALAND PROPERTY DESIGN CONTRIBUTE TO DRIVEWAY RUNOVERS?
THE INCIDENCE, SEVERITY AND ETHNIC DISTRIBUTION OF JUVENILE SYSTEMIC LUPUS
ERYTHEMATOSUS (JSLE) SEEN AT STARSHIP HOSPITAL OVER A 4 YEAR PERIOD
HUMAN PROGENITOR CELL AND IMMATURE RETICULOCYTE FRACTION EVALUATION FOR
THE TIMING OF PERIPHERAL BLOOD STEM CELL HARVEST COLLECTION
INSULIN PUMPS IN A PUMP-NAÏVE REGIONAL POPULATION
DOES CT PATTERN PREDICT DYSPNOEA IN SARCOIDOSIS?
FATIGUE AND EXERCISE CAPACITY IN SARCOIDOSIS
VALIDATION OF SARCOIDOSIS HEALTH QUESTIONNAIRE IN A EUROPEAN POPULATION
IMPORTED MALARIA IN AUCKLAND
CATHETER-RELATED COMPLICATIONS IN HPN PATIENTS IN AUSTRALIA AND NEW ZEALAND
DURING 2009
TRANSABDOMINAL CERVICAL CERCALGE (TACC) FOR WOMEN AT VERY HIGH RISK OF EARLY
PRETERM BIRTH – OUTCOMES AND COMPLICATIONS
UNEXPECTEDLY HIGH WHOLE BLOOD CHLORIDE LEVELS IN A SEVERE BURNS PATIENT
CAUSED BY WOUND TREATMENT WITH CERIUM NITRATE
PRESCRIBING GUIDELINES: HOW DOES STARSHIP HOSPITAL MEASURE UP?
MYCOPHENOLATE MOFETIL (MMF) USE IN LIVER TRANSPLANTATION IN NEW ZEALAND
PILOT STUDY OF hsTnT COMPARED TO cTnT: PATIENT OUTCOMES AND IMPLICATIONS FOR
CLINICIANS
hsTroponinT: IS 53 REALLY THE NEW 30?
PREVALENCE OF ACCESS BLOCK IN NZ EMERGENCY DEPARTMENTS IN 2010 AND THE EFFECT
ON THE SHORTER STAYS IN ED TARGET
VALIDATION OF A TOOL TO PREDICT EMERGENCY DEPARTMENT LENGTH OF STAY
SNAPSHOT OF ETHNICITY IN AUCKLAND MEDICAL ONCOLOGY CLINICAL TRIALS
EVALUATION OF CANDIDATE GENES IN PATIENTS WITH COMMON VARIABLE
IMMUNODEFICIENCY
PROSTHETIC HIP RELOCATION IN THE EMERGENCY DEPARTMENT AND OPERATING
THEATRES OF AUCKLAND CITY HOSPITAL
DIAGNOSTIC AND STAGING EFFICACY OF EBUS-TBNA PERFORMED UNDER CONSCIOUS
SEDATION IN SUSPECTED THORACIC MALIGNANCY
ACUTE CORONARY SYNDROME PATIENTS TREATED WITH CORONARY ARTERY BYPASS
SURGERY HAVE POOR CHOLESTEROL CONTROL AND SIGNIFICANT ADVERSE EVENTS AT
REVIEW 3 YEARS LATER
ACUTE CORONARY SYNDROME PATIENTS TREATED WITH PERCUTANEOUS CORONARY
INTERVENTION: POTENTIAL FOR SIGNIFICANT SOCIO-ECONOMIC BURDEN FROM ADVERSE
EVENTS DUE TO POOR CHOLESTEROL CONTROL AT REVIEW 3 YEARS LATER
PREOPERATIVE MRI ASSESSMENT OF DEPTH OF MYOMETRIAL INVASION IN ENDOMETRIAL
CANCER
5
5
6
6
7
7
7
8
8
9
10
10
11
11
12
12
13
13
14
14
15
15
16
16
16
17
18
19
19
2
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
HIGH MORTALITY AND MORBIDITY IN ACUTE CORONARY SYNDROME PATIENTS WHO
RECEIVED MEDICAL (NON-REVASCULARISATION) MANAGEMENT
ACUTE CORONARY SYNDROME PATIENTS TREATED WITH CABG SURGERY: SUBOPTIMAL USE
OF SECONDARY PREVENTION MEDICATIONS AT REVIEW 3 YEARS LATER
MEASUREMENT OF SERUM RIFAMPICIN BY HIGH-PERFORMANCE LIQUID
CHROMATOGRAPHY WITH ULTRAVIOLET DETECTION. SAMPLE PREPARATION AND STABILITY
CONSIDERATIONS
CHILD AND FAMILY EXPERIENCES OF PAEDIATRIC RHEUMATOLOGY CARE IN NEW ZEALAND
HUMIDIFICATION OF LOW FLOW OXYGEN THERAPY FOR INFANTS AND YOUNG CHILDREN.
PILOT STUDY REPORT
ADEQUACY OF INFORMATION GIVEN TO PATIENTS WITHIN THE SPEECH LANGUAGE
THERAPY (SLT) SERVICE: A PATIENT AND CARER PERSPECTIVE
PSYCHOLOGICAL WELL-BEING OF ADOLESCENT SURVIVORS OF CHILDHOOD CANCER IN NEW
ZEALAND: A NATIONWIDE STUDY
DETECTING ACUTE NEUROTOXICITY DURING PLATINUM CHEMOTHERAPY BY
NEUROPHYSIOLOGICAL ASSESSMENT OF MOTOR NERVE HYPEREXCITABILITY
NISSEN FUNDOPLICATION POST LUNG TRANSPLANT: COMPLICATION RATES AND EFFECTS
ON BOS PREVALENCE
IDENTIFYING ASPIRATION AND REDUCING PNEUMONIA IN STROKE PATIENTS USING COUGH
REFLEX TESTING
THE AUCKLAND BREAST CANCER REGISTER
AUDIT OF APHASIA THERAPY AND THE ICF
EPIDEMIOLOGY OF INVASIVE FUNGAL INFECTIONS IN AT RISK HAEMATOLOGY PATIENTS IN
AUCKLAND CITY HOSPITAL (2006 – AUG 2010)
DOES EXPRESSION OF THE GASTRIC MUCIN MUC6 HELP IDENTIFY ADVANCED SERRATED
COLORECTAL POLYPS?
EXTENT OF BOWEL RESECTION IN YOUNG PATIENTS WITH COLORECTAL CANCER (CRC):
WHAT IS HAPPENING?
MISMATCH REPAIR GENE PROTEIN EXPRESSION IN YOUNG PATIENTS WITH COLORECTAL
CANCER: THE EIGHT YEAR AUCKLAND EXPERIENCE
CARDIOVASCULAR MEDICATION USE FOLLOWING KIDNEY TRANSPLANT: DATA FROM THE
PORT INTERNATIONAL DATA COLLABORATION
EVALUATION OF COBAS® 4800 TEST FOR HUMAN PAPILLOMA VIRUS (HPV) DETECTION AND
GENOTYPING IN CERVICAL SPECIMENS
CAUSE FOR CELEBRATION: INCREASED ADHERENCE WITH HAND HYGIENE RESULTS IN A
BETTER OUTCOME FOR PATIENTS WITHIN ADHB HOSPITALS
MOLECULAR EPIDEMIOLOGY AND SUSCEPTIBILITY PROFILES OF CLOSTRIDIUM DIFFICILE
ISOLATES IN NEW ZEALAND, 2009
PHARMACOKINETIC STUDY OF INTRAVENOUS LEVETIRACETAM IN TERM NEONATES WITH
SEIZURES
COORDINATION OF THE HITBIC TRIAL QUALITY SCREENING VS QUIETLY SCREAMING. IT’S ALL
SO EASY IN RETROSPECT!
PDA- IT’S THE ONLY WAY
ANTIMICROBIAL CONSUMPTION AT AUCKLAND CITY HOSPITAL 2006-2009
AUDIT OF DISCHARGE PRESCRIPTIONS ON OLDER PEOPLE’S HEALTH (OPH) WARDS AT
AUCKLAND DISTRICT HEALTH BOARD (ADHB)
PARENTAL KNOWLEDGE OF AND ATTITUDES TOWARD THE HUMAN PAPILLOMAVIRUS
VACCINE
RATES OF DRUG RESISTANT MYCOBACTERIUM TUBERCULOSIS AMONGST HIV-POSITIVE
PATIENTS, PHNOM PENH, CAMBODIA
20
22
23
23
24
24
24
25
26
26
27
27
27
28
28
29
29
30
31
31
32
32
33
33
34
34
35
3
57
58
59
60
61
62
63
DOES THE READY-FOR-WORK PROGRAMME IMPROVE INTERNATIONAL MEDICAL GRADUATE
(IMG) RETENTION?
LEFT VENTRICULAR ASSIST DEVICES – THE NEW ZEALAND EXPERIENCE
SIMULTANEOUS MEASUREMENT OF RETINOL, TOCOPHEROL AND B-CAROTENE IN SERUM
BY REVERSED PHASE HPLC: CONSIDERATION OF CHROMATOGRAPHIC CONDITIONS
ENOXAPARIN USAGE FOR VENOUS THROMBOEMBOLISM PREVENTION IN SURGICAL WARDS
AT AUCKLAND DISTRICT HEALTH BOARD (ADHB)
AN AUDIT OF CARDIOVASCULAR RISK FACTOR MONITORING IN ACUTE ADULT INPATIENT
MENTAL HEALTH WARDS AT AUCKLAND DHB
DEVELOPING A WHOLE-SYSTEM PERSPECTIVE OF PATIENT FLOW
REDUCING OCCUPANCY AND EMERGENCY DEPARTMENT WAIT TIMES FOR GENERAL
MEDICINE PATIENTS BY INCREASING LEVELS OF WEEKEND SERVICE – A SIMULATION STUDY
35
36
36
36
37
37
38
4
1. ESTABLISHMENT OF A NATIONAL FAMILIAL GASTROINTESTINAL CANCER REGISTRY: A PRELUDE TO
BOWEL CANCER SCREENING
S. Parry, J. Collett, J. Arnold, H. Brunton, J. Lomas
NZ Familial Gastrointestinal Cancer Registry, Auckland City and Christchurch Hospitals, New Zealand.
In anticipation of population screening for colorectal cancer (CRC) national guidelines for the surveillance
and management of individuals at increased risk of developing CRC were published in May 2004.
These guidelines recommended that surveillance colonoscopy should be available within the public
hospital system for individuals identified, on the basis of their family history, to be at moderate risk of
developing CRC. The recommendation was also made that families with hereditary CRC syndromes should
be offered referral to a national familial bowel cancer registry because of the emerging evidence that such
registries can reduce the incidence of cancer in these families.
In June 2007 the Ministry of Health funded a project to incorporate two previously distinct regional
registries and the New Zealand Familial Gastrointestinal Cancer Registry (NZFGICR) was established in July
2008. As well as facilitating the diagnosis of hereditary gastrointestinal cancer the NZFGICR will provide
education for families and medical practitioners and co-ordinate surveillance colonoscopy for registered
families, wherever they reside in NZ. The National Registry is hosted by the Auckland District Health
Board.
The taskforce responsible for the oversight of population screening for CRC can now be confident that
when an individual is invited to participate in the population screening programme, a strategy is in place
for those who are thereafter identified to be at high risk of developing CRC.
2. MULTICOLOUR IMMUNO-FLUORESCENCE OF PARAFFIN EMBEDDED HODGKIN LYMPHOMA LYMPH
NODES
C. Mansell 1,2, L. Berkahn3, R. Dunbar 1,2.
1
School of Biological Sciences, University of Auckland, Auckland, New Zealand, 2 The Maurice Wilkins
Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand, 3 University of
Auckland and Auckland City Hospital, Auckland, New Zealand
Hodgkin Lymphoma (HL) is one of the most common forms of lymph node cancer in the Western world.
Hodgkin and Reed-Sternberg (HRS) cells, despite being the neoplastic cells of HL, typically only account for
around 1% of the HL tumour.
In the clinic, paraffin blocks of diagnostic biopsies from HL patients are usually examined using single
colour immunohistochemical stains, making it difficult to unequivocally identify HRS cells.
We have developed a multi-colour immunofluorescence technique that enables the simultaneous
visualisation of up to four markers in Formalin-fixed Paraffin-embedded (FFPE) tissue. We have examined
FFPE lymph node sections from HL patients in order to further characterize the HRS cell and its
microenvironment in its “natural state”.
Within the tumour microenvironment TIA-1 and CD68 as negative prognostic markers and Foxp3 as a
positive prognostic marker. We examined the cell sub-types expressing these markers and differences in
marker expression between patients with different HL subtypes and patients with different outcomes. We
show that unequivocal identification of HRS cells in a single section is possible by simultaneously staining
for CD15, CD30 (or CD45), CD20 and DAPI. Preliminary results suggest that there are differences in
expression patterns of CD30 and CD15 between different HRS cells. Also, these markers can have variable
localisation patterns within HRS cells. Overall, these results demonstrate the potential of multi-colour
fluorescent staining as a useful tool for the clinic.
5
3. THE OUTCOME OF PATIENTS WITH DIFFUSE LARGE B CELL LYMPHOMA WHO PROGRESS AFTER RCHOP CHEMOTHERAPY
L. Berkahn, P. Browett, R. Doocey, T. Hawkins, F. McGuire, N. Patton
Department of Haemotology, Auckland City Hospital
Rituximab treatment has vastly improved the prognosis for patients diagnosed with large B-cell
lymphoma. Patients aged 60-80 treated with rituximab as part of first line therapy improved 5 year event
free survival from 29% to 47%4, and 3 year event free survival in those aged 18-60 was improved from
59% to 79%5. If progression of disease occurs during or after treatment with chemotherapy
supplemented with rituximab, secondary curative treatment is either R-ICE or R-DHAP salvage
chemotherapy, followed by BEAM conditioning and autologous stem cell transplant (ASCT). We
retrospectively reviewed the outcomes of patients treated in the Auckland area since 2004 when
Rituximab therapy was introduced.
19/25 (76%) patients <60 years old were given salvage chemotherapy, compared to only7% (2/27) in
patients ≥60 years old. None of the older group received ASCT or achieved remission, while 32% (8/25) of
the younger group received ASCT, and 24% (6/25) in ongoing remission.
With a mean follow-up of 2.01 years, the overall survival was 33% (7/21) in those who received salvage
chemotherapy.
Early progression, less than 6 months from diagnosis, predicted for worse outcome than later progression
with 6% (2/36) achieving remission compared to 25% (4/16) in those progressing later.
Age was important: no patient over 60 years of age who subsequently relapsed is alive without disease,
compared with 24% in those aged <60 years at diagnosis. Overall survival in these two groups was 7% and
28% respectively.
4. THE EXPERIENCE OF YOUNG PEOPLE WITH JIA TRANSFERRED FROM PAEDIATRIC TO ADULT SERVICES
J. Blamires1, A. Dickinson2
1
Paediatric Rheumatology , 2AUT
Background: Juvenile Idiopathic Arthritis (JIA) affects 1 in 1000 children and young people (YP). At least
one third will require transfer to an adult rheumatology service. While the need for adolescent transition
services is acknowledged, transfer from paediatric to adult services is still often overlooked. Reports
suggest that even with an established transition programme, there is no guarantee of successful transfer.
There is currently no formal transitional care program and little is known locally about the challenges
these YP face as they move on from paediatric services.
Objectives: To identify the factors that facilitate or challenge the transfer of YP with JIA from paediatric to
adult services.
Methods: Data was collected via a semi-structured focus group interview with 8 YP with JIA, who had
recently transferred from paediatric to adult rheumatology services.
Results: Three themes were identified. It’s time to move on signalled the YP’s readiness for transfer.
Preparing for transfer described the process of getting ready to move and blending in indicated their
arrival and adjustment to adult services.
Conclusion: This study indicates that when a young person signals their readiness for transfer, a
transparent and individualised process needs to be put in place. The need for details surrounding the
adult setting was considered essential and emphasized that adult rheumatology services need to allow
time for the young person to adjust and integrate into the new environment.
6
5. BREAST CANCER, ILLNESS PERCEPTIONS & ADHERENCE TO AROMATASE INHIBITORS
R.J. Broom, A. Corter, K. Petrie, M. Findlay, D. Porter
Purpose: Adjuvant aromatase inhibitors reduce the morbidity and mortality associated with breast cancer
recurrence, but adherence is a significant problem. This study examines the relations between
demographic factors, fear of cancer recurrence, illness perceptions, depression and anxiety, and selfreported adherence to aromatase inhibitors in the previous 30 days.
Methods: A sample of 159 women currently taking aromatase inhibitors completed an anonymous postal
survey (58% response rate) that included the Brief Illness Perception Questionnaire, Hospital Anxiety and
Depression Scale, a measure of fear of cancer recurrence, and self reported adherence to aromatase
inhibitors.
Results: Adherence was generally high but 26% of women reported missing at least one dose of
medication over the past month. Preliminary analyses showed that non-adherence was unrelated to age,
number of medications or time on treatment. Non-adherence was also unrelated to levels of anxiety,
depression or fear of cancer recurrence. However, the number of doses missed over the previous month
was significantly associated with a higher belief in personal control over breast cancer recurrence (r= .23,
p=.006) and a belief that breast cancer had more severe negative impacts on their lives (r= .194, p= .019).
Side effects were unrelated to adherence in this sample.
Conclusion: Personal beliefs about control over breast cancer recurrence and about the consequences of
breast cancer may weaken long-term adherence to aromatase inhibitors.
6. DOES NEW ZEALAND PROPERTY DESIGN CONTRIBUTE TO DRIVEWAY RUNOVERS?
J. Chambers1, P. Austin2, M. Shepherd3
1
Starship Trauma Service, Auckland; 2 School of Architecture and Planning, National Institute of Creative
Arts and Industries, The University of Auckland; 3 Paediatric Emergency Department, Starship Children’s
Health
Driveway run-over injuries are a frequent cause of paediatric mortality and morbidity. Driveway run-overs
occur as a result of an interaction between human factors (child and driver), vehicle factors and
environmental factors (driveway design, driveway surroundings). This was a case control study; with 88
case properties where a driveway injury (age < 7 years) requiring hospital admission had occurred. The
181 control properties were selected from addresses of children presenting to Emergency Department
with a non-driveway injury. Blinded assessment used satellite images, site visits and searches of council
records. Risk of injury increased by; a driveway length of greater than 12 metres (OR 1.8 95%CI 1.1-3.0),
exiting the driveway onto a local road (OR 5.5 95%CI 2.7-11.2) and the driveway exiting onto a cul de sac
(OR 2.3 95%CI 1.4-3.9). It was also increased when more parking areas were on the property (requiring
the use of the driveway to access) (OR 3.0 95%CI 1.6-5.4). The presence of a separate pedestrian pathway
on the property was associated with a lower risk of injury (OR 0.4 95%CI 0.2-0.9). Built environment
features contribute to driveway run over injuries.
7. THE INCIDENCE, SEVERITY AND ETHNIC DISTRIBUTION OF JUVENILE SYSTEMIC LUPUS
ERYTHEMATOSUS (JSLE) SEEN AT STARSHIP HOSPITAL OVER A 4 YEAR PERIOD
A. Concannon1, J. Yan2
1
Paediatric Rheumatology Fellow,
Children’s Health.
Starship Children’s Health, 2Paediatric Rheumatologist, Starship
Background: The Paediatric Rheumatology service at Starship is the tertiary referral centre for children
under 16 years of age within the Auckland and greater North island region. There is no published data
7
describing the incidence, severity and ethnic distribution of connective tissue diseases (CTD) in New
Zealand children.
Aim: To determine the incidence, ethnic distribution and severity of JSLE of patients seen between 20062010.
Methods: We performed a retrospective review of children with JSLE, seen by our service (2006 to 2010).
Ethnicity, lupus manifestations, severe lupus nephritis, end stage renal failure, death and diagnostic BILAG
scores were recorded.
Results: Of the 50 children with CTD, 26 had jSLE. Maori and Polynesian children were over represented.
They had the highest BILAG lupus severity scores and a large proportion had severe lupus nephritis. The
only cases of ESRF and death occurred in Maori children.
Conclusion: Maori and Polynesian children are over represented among children with connective tissue
diseases and severe lupus manifestations. This small and retrospective study supports the previous
anecdotal reports of a higher incidence of connective tissue diseases and more severe lupus
manifestations among Maori children.
Acknowledgments: Starship Foundation fellowship grant and Paediatric Renal service at Starship Hospital.
8. HUMAN PROGENITOR CELL AND IMMATURE RETICULOCYTE FRACTION EVALUATION FOR THE TIMING
OF PERIPHERAL BLOOD STEM CELL HARVEST COLLECTION
S. Corboy
The administration of haemopoietic growth factors, with or without high dose chemotherapy, combined
with Peripheral Blood Stem Cell Harvest (PBSCH) collection for autologous and allogeneic bone marrow
transplantation has become a common and important treatment for various haematological malignancies.
Optimal timing of the PBSCH is dependent on the level of CD34+ cells in the peripheral blood.
Quantitation of CD34+ cells by flow cytometry is expensive, time consuming and requires a high level of
technical expertise. The Sysmex XE-2100 haematology analyser can quickly identify Human Progenitor
Cells (HPC) populations in peripheral blood and has been shown to have good correlation with CD34+ cell
detection. An additional XE-2100 parameter, the Immature Reticulocyte Fraction (IRF), is also a marker for
predicting the appropriate timing for harvest collection.
This study investigated using HPC and IRF results from a Sysmex XE-2100 analyser for the timing of PBSCH
collection as an alternative to CD34+ cell analysis. Our findings confirmed that of numerous evaluations
that HPC has good correlation with CD34+ cell detection and we hope to use this parameter
as a rapid, simple and inexpensive screening test for PBSCH timing.
9. INSULIN PUMPS IN A PUMP-NAÏVE REGIONAL POPULATION
M. de Bock1, P. Reed2, J. A. Holt2, G. Harris2, C. Adamson2, W. Cutfield1, F. Mouat2, P. Hofman1, A. Gunn3, ,
C. Jefferies2
1
Liggins institute, University of Auckland; 2Starship Children’s Health; 3Department of Physiology,
University of Auckland.
Background: Insulin pump therapy is still a relatively new and untried method of insulin delivery for
children with type 1 diabetes (T1DM) in New Zealand.
Objectives: To examine the clinical impact of insulin pump therapy with T1DM in our pump-naïve regional
population, and compare to an age-matched control population.
8
Methods: Retrospective analysis of the Auckland Paediatric Diabetes database from 1 January 2002 to
31 December 2008.
Results: From 621 subjects there were 75 on insulin pumps, with a total of 6680 clinical visits. The mean
age at pump start was 10.2 years, 93% of subjects were European, 53% females, time from diabetes
diagnosis to pump start 4.3 ±2.7years (0.5–11.8 years). Pump patients were also compared to an age-sexmatched group for length of diabetes (n =75). Pump patients showed improved HbA1c (0.3% per year;
p<0.001) up to 3 years after starting insulin pump. Hypoglycaemia rates decreased after pump initiation,
and DKA rates remained low in both pump and non-pump controls. There was a difference in HbA1c
before pump start (-0.6% at 24 months pre-pump), but no change in BMI before or after insulin pump.
Conclusion: In our pump-naive regional population insulin pump therapy is a safe and effective option,
with improvements in HbA1c and lower hypoglycaemia rates.
10. DOES CT PATTERN PREDICT DYSPNOEA IN SARCOIDOSIS?
S. de Boer, D. Milne, J. Kolbe, M. Wilsher
Green Lane Respiratory Services, Level 7, Support Building, Auckland City Hospital
Introduction: Dyspnoea and exercise limitation are common symptoms in sarcoidosis but are often
unexplained by resting pulmonary function (PF). The aim of this study was to see if CT pattern of disease
can predict dyspnoea and exercise limitation.
Methods: 40 patients (23 male, mean 50.5yrs, 80% European) underwent CT chest and cardiopulmonary
exercise test. CT patterns scored were nodules, reticular, ground-glass, mosaic attenuation and massive
fibrosis. Borg score of breathlessness was recorded at peak exercise.
Results: Mean FEV% 76.5, FVC% 90.9, DLCO% 72.8. There was a significant difference in Borg score (mean
4.7) and peak VO2% (mean 69.3) between male and female patients (p0.001, p<0.0001). Neither Borg
score nor peak VO2% correlated with resting PF. Extent of nodules (r=0.349, p0.029) and ground-glass
(r=0.370, p0.02) correlated with peak VO2%; Borg score correlated best with %abnormal lung (r=0.476,
p0.002) but also with nodules (r=0.383, p0.016) and reticular pattern (r=0.374, p0.019). However no CT
pattern remained a significant predictor once controlled for gender.
Conclusion: CT patterns of sarcoidosis correlate with symptoms of dyspnoea and exercise capacity better
than resting PF parameters but the only independent predictor of exercise limitation was gender. These
data suggest that non-pulmonary factors influence exercise capacity in sarcoidosis patients.
Acknowledgments: Myrtle Martin Fund and Green Lane Hospital Research and Education Fund.
9
11. FATIGUE AND EXERCISE CAPACITY IN SARCOIDOSIS
S. de Boer, J. Kolbe, M. Wilsher
Green Lane Respiratory Services, Level 7, Support Building, Auckland Hospital
Introduction: Fatigue, breathlessness and exercise intolerance are common symptoms in sarcoidosis. The
aim of this study was to determine the relationship between exercise capacity and symptoms of fatigue
and breathlessness.
Methods: 55 (30 male, mean age 51yrs, 75% European) patients with sarcoidosis completed the fatigue
assessment scale (FAS) followed by a STEEP protocol cardiopulmonary exercise test. A Borg score of
breathlessness was recorded at peak exercise. Demographic and pulmonary function data were collected.
Results: Mean FEV1% 76, FVC% 91, DLCO% 73. Mean FAS 20.9 (SD 6) with FAS>22 in 44% patients.
Patients who reported symptoms of breathlessness and exercise limitation had significantly higher FAS
(p0.02, p0.01 respectively) however the Borg score did not correlate with FAS. A negative correlation was
seen between FAS and VO2 (r=-0.38, p0.007), O2 pulse (r=-0.377, p0.006) and minute ventilation (r=-0.322,
p0.02). Breathing reserve correlated with FAS (r=0.313, p0.02). DLCO was the only resting pulmonary
function parameter to correlate with FAS (r=-0.319, p0.03).
Conclusion: Fatigue is associated with significantly reduced exercise capacity in sarcoidosis patients, but
not with impairment of resting lung function measures, with the exception of DLCO. Breathlessness
measured at peak exercise does not correlate with fatigue.
Acknowledgments: Myrtle Martin Fund and Green Lane Hospital Research and Education Fund.
12. VALIDATION OF SARCOIDOSIS HEALTH QUESTIONNAIRE IN A EUROPEAN POPULATION
S. de Boer, M. Wilsher
Green Lane Respiratory Services, Level 7, Support Building, Auckland City Hospital
Introduction: The Sarcoidosis Health Questionnaire (SHQ), developed in United States with 80% African
American population, assesses health status and quality of life of sarcoidosis patients. It is not known if
the SHQ is applicable to populations with different ethnicities, organ involvement and severity. The aim of
this study was to validate the SHQ in a predominantly European population.
Methods: Consecutive outpatients (n=92) with a diagnosis of sarcoidosis, completed 3 questionnaires
(SHQ, Short Form 36 Survey, Fatigue Assessment Scale) and pulmonary function tests.
Results: Mean age 51yrs, 74% European. 95% participants had pulmonary involvement, mean FEV1
74.4%, FVC 84.6%. The SHQ total score (mean 5.13) demonstrated significant correlations with the SF36
PCS (mean 46.7, r=0.78) and FAS (mean 20.8, r=-0.7) but only weak correlation with pulmonary function.
There was a significant difference between SHQ scores when separating patients by clinical
characteristics; symptoms, p<0.0001; oral therapy, p = 0.0001; health status, p<0.0001; FEV1 >70%, p =
0.008; FVC >70%, p = 0.01.
Conclusion: SHQ correlates well with HRQL and fatigue measures in a predominantly European population
of sarcoidosis patients. The divergent qualities of the SHQ are maintained despite different organ and
disease burden to the development study.
Acknowledgements: Myrtle Martin Trust and Green Lane Hospital Research and Education Fund.
10
13. IMPORTED MALARIA IN AUCKLAND
A. Elinder Camburn, J. Ingram
Rates of malaria have fallen in a number of endemic countries recently and a corresponding drop in the
number of imported cases have been seen in several high income countries. Our aim was to describe the
current malaria situation in Auckland. Over a 12 month period we asked the haematology laboratories in
Auckland to notify us of all new cases of malaria diagnosed in Auckland. Following informed consent,
clinical and laboratory data relating to each case of malarial infection were collected. Overall data was
collected for 34 episodes of malaria diagnosed in 32 patients. 11 were New Zealand residents (3
missionaries / aid workers, and 8 people who returned to their country of origin to visit friends and
relatives “VFR”), 10 were “new entrants” – ie. migrants who had moved to New Zealand for study or
work, and 11 were African refugees. Of the 34 episodes of malaria, P.falciparum was diagnosed in 18 and
P.vivax in 16 patients, and the average age at the time of diagnosis was 24 years. No case of malaria was
diagnosed in New Zealand tourist traveling to a malarial area.
14. CATHETER-RELATED COMPLICATIONS IN HPN PATIENTS IN AUSTRALIA AND NEW ZEALAND DURING
2009
L. Gillanders1, K. Angstmann2, P. Ball3, M. O’Callaghan4, A. Thomson5, T. Wong6
1
Auckland City Hospital, Auckland, New Zealand; 2 Royal North Shore Hospital, Sydney, 3 Charles Sturt
University, Wagga Wagga, 4 Flinders Medical Centre, Adelaide, 5 The Canberra Hospital, Canberra, 6 Royal
Children’s Hospital, Melbourne, Australia
Rationale: Central Venous Access Device (CVAD) related problems are considered one of the major
management problems for patients on Home Parenteral Nutrition (HPN) but evidence is lacking
quantifying morbidity, mortality and economic impact.
Methods: Catheter-related complications in all patients cared for by the HPN services of 4 hospitals in
Auckland, Adelaide, Melbourne and Sydney, between 31/01/-31/12/2009, were recorded prospectively.
Results: 53 patients (11 aged <16) received a total of 447 months of HPN.
There were 49 episodes in 27 patients of CVAD-related complications, all involved patients with tunnelled
lines except for one patient with a percutaneously inserted central catheter (PICC), and one with an
implanted port catheter. 15 episodes occurred in multi-use catheters.
Complications included:
Line sepsis - (1 / 400*), line blockage/thrombus (1/2,200*), line migration (1/13,500*), line fracture
(1/1,900*)
* approximate incidence/days of therapy
The 36 episodes of line sepsis included:
25 with bacteraemia, 8 without bacteraemia but with positive exit site cultures, 3 without any positive
microbiology
The most frequently isolated organisms were:
S. aureus, K. pneumoniae, Enterobacter species, Candida species
33 patients were treated with IV antibiotics.
No patient died but 37 episodes resulted in hospital admission for an average of 8 days (range 1-29).
The average cost of care per episode was A$9710.
Conclusion: This is the first multicentre prospective audit of CVAD-related complications in HPN patients.
11
15. TRANSABDOMINAL CERVICAL CERCALGE (TACC) FOR WOMEN AT VERY HIGH RISK OF EARLY
PRETERM BIRTH – OUTCOMES AND COMPLICATIONS
K. M. Groom 1, 2, R. Bhat 2, P.R. Stone 1.
1
Department of Obstetrics and Gynaecology, FMHS, University of Auckland, Auckland; 2Department of
Obstetrics and Gynaecology, National Women’s Health, Auckland City Hospital, Auckland
Aim: To report pregnancy outcome and complication rates for women with recurrent late pregnancy loss
and early preterm birth managed by TACC at National Women’s Health, Auckland City Hospital.
Methods: A case note review of nine women treated with TACC from 2003 to 2010.
Results: Five women were referred from other obstetric units. Prior to surgery these women had a mean
of 1.6 second trimester losses or deliveries <30weeks (range 0-3). All women had previous cervical surgery
or trauma, six had previous transvaginal cerclage and all had very short vaginal cervices making
transvaginal cerclage not possible. Eight were performed during pregnancy, one was performed
preconception. No significant intra-operative complications occurred.
Postoperatively there have been nine pregnancies >34weeks and one delivery at 33 weeks following
preterm prelabour rupture of membranes (PPROM). All were delivered by caesarean section. There was
one case of PPROM and intrauterine fetal death at 23weeks, this was managed by dilatation and
evacuation with no complications.
Conclusion: TACC was associated with a postoperative fetal survival rate of 91% for pregnancies reaching
>12weeks compared to a preoperative fetal survival rate of 44%. Within this case series TACC was
associated with improved outcomes in women at very high risk of early preterm birth associated with
cervical damage.
16. UNEXPECTEDLY HIGH WHOLE BLOOD CHLORIDE LEVELS IN A SEVERE BURNS PATIENT CAUSED BY
WOUND TREATMENT WITH CERIUM NITRATE
L, Ha,1,2 G. A. Woollard,2 W. Chiu2
1
Clinical Biochemistry laboratory, Middlemore Hospital, Auckland, New Zealand; 2Department of Chemical
Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand
Introduction: A teenage male suffered severe burns after an accident in Tahiti. He was transferred two
days later to the National Burn Centre at Middlemore Hospital. Unphysiologically high levels of whole blood
chloride were noted by Radiometer ABL800 blood gas analyser. Paired plasma chlorides measured by
Abbott Architect Ci 8200 autoanalyser were much lower. We suspected interference to the chloride
electrode of ABL800 and investigated for the possible interferent(s).
Methods: Patient’s plasma nitrate, bromide, thiocyanate and iodide were measured. The in-vitro effect of
nitrate on ABL800 and C8 chloride measurements was tested by spiking blank pooled plasma with
increasing concentrations of sodium nitrate.
Results: Patient’s whole blood chloride levels (ABL800) were 170mmol/L, 137mmol/L, and 119mmol/L
(from post-burn day 3,4 and 5 respectively) with corresponding plasma nitrate at 6.7mmol/L, 4.9mmol/L
and 1.1mmol/L. (reference limit <0.08mmol/L). The decrease in chloride paralleled the decrease in nitrate
over the five days of observation. In-vitro spiking with 7mmol/L nitrate gave an apparent plasma chloride
level of 190mmol/L from ABL800. Thiocyanate was not detected and bromide 0.045mmol/L and iodide
fluctuating <150nmol/L.
Conclusion: Enquiries with the Tahiti hospital confirmed that cerium nitrate (Flammacerium) had been
applied topically to his burn wounds. No nitrate containing medications had been given in New Zealand.
12
We suggest systemic absorption of nitrate from cerium nitrate has caused the positive interference on
chloride measurement on Radiometer ABL800 blood gas analyser.
17. PRESCRIBING GUIDELINES: HOW DOES STARSHIP HOSPITAL MEASURE UP?
L. Hill, J. Woodfield
Starship Hospital, Auckland
Introduction: 1.5% of hospital prescriptions result in prescribing errors, with obvious consequences to
patient safety. Local and national guidelines aim to decrease error frequency. We audited Starship
Hospital (SSH) medication charts to ascertain guideline adherence.
Methods: Prescription charts for SSH inpatients were audited on 16/10/10. The audit criteria were
derived from the Medical Council of New Zealand, SSH and New Zealand Medicines Regulation 1984
guidelines.
Results: 135 prescription charts were audited. All charts documented patient name, address and date of
birth. 129 (96%) documented patient weight and 122 (90%) allergy history. 57 (42%) charts documented
the prescriber’s full name and 54 (40%) the prescriber’s MCNZ number. All prescriptions were signed. 133
(99%) had full instructions on drug administration. 125 (93%) charts were legible. All ceased medication
was clearly discontinued. 6 of 76 charts (8%) with antibiotic prescriptions had review dates.
Discussion: This audit identified areas for improvement. Allergy history was not documented in 7% of
charts and 7% were not legible with obvious patient safety implications. 92% of antibiotic prescriptions
had no stop dates which may have led to inappropriate course length.
Education is imperative to address these shortfalls which likely demonstrate lack of awareness of
prescribing guidelines.
18. MYCOPHENOLATE MOFETIL (MMF) USE IN LIVER TRANSPLANTATION IN NEW ZEALAND
J. C. Hsiang, B. Harrison, R. Harry
NZLTU, Auckland City Hospital
Aim: To audit the use of MMF in liver transplantation in New Zealand.
Methods: Patients treated with MMF between 2004 and February 2010 were identified retrospectively
from Pharmac databases and divided into 2 groups; A: MMF as primary immunosuppression as part of a
renal protection protocol with IL2 receptor antibody, steroids and delayed tacrolimus and B: those
switched to MMF based second line therapy (B). Clinical data was retrieved from NZLTU database.
Results: 61 patients were identified for study (13 Group A, 48 group B) with most (79%) started on MMF
since 2008.
In group A, the renal protection protocol was adhered to in each case in the first week but none received
therapy to one year. During MMF therapy (93 days IQR 148), 2 patients (15.4%) developed 4 episodes of
acute rejection (ACR). None developed CMV.
In group B, MMF was started 361 days (IQR 1617) after transplant. In 29 patients (60%) this was for renal
impairment. 8 of these (28%) underwent renal US, 14 (48%) MSU and 6 (20%) formal creatinine clearance
as per switching protocol. During MMF therapy (441 days IQR 105), 11 patients (22.9%) had 21 episodes
of ACR and 4 patients (8%) developed CMV.
Conclusion: Use of MMF post liver transplant in New Zealand is increasing. ACR and CMV occur during its
use. Further study is required to assess the clinical importance of these findings.
13
19. PILOT STUDY OF hsTnT COMPARED TO cTnT: PATIENT OUTCOMES AND IMPLICATIONS FOR
CLINICIANS
S. Jairam 1 , P. Jones1 , L. Samaraie 2 , A. Chataline 2 , R. Stewart 2, J. Davidson3, M. Lee 2 , T. Wang1
1
Adult Emergency department, 2Greenlane Cardiovascular Service, 3 Laboratory Services, Auckland City
Hospital.
High sensitivity troponin T (hsTnT) detects lower levels of cardiac troponin T with higher precision than 4 th
generation (cTnT) assay, but the clinical implications of this new test are uncertain.
Objectives: Describe clinical characteristics and 90 day outcomes for patients with positive or negative
hsTnT compared to those with a positive or negative cTnT.
Methods: Consecutive blood samples sent for measurement of TnT in 161 patients were tested with both
assays. Patient records were reviewed retrospectively. Two senior clinicians independently reviewed the
‘new positive’ group to assign a diagnosis, blind to hsTnT results. Coronary artery revascularization, acute
myocardial infarction (AMI), readmission and deaths were determined to 90 days.
Results: N of patients with detectable troponin more than doubled with the hsTnT compared to the cTnT
assay (50% versus 22%, p<0.0001). 81 patients tested negative with both assays, 44 were cTnT
negative/hsTnT positive and 36 were positive for both assays. Adverse events occurred in 30%, 54% and
50% of each group respectively. The primary diagnosis in patients only positive with hsTnT assay was
myocardial infarction in 9%, other cardiac in 32%, and other medical in 59%. AMI or cardiovascular
death occurred in 4 cases, which were positive on both assays.
Conclusion: Patients with TnT detected only with the high sensitivity assay had worse outcomes at 90
days, but most did not have AMI.
20. hsTroponinT: IS 53 REALLY THE NEW 30?
P. Jones1, S. Jairam 1, R. Stewart 2, L. Samaraie 2, A. Chataline 2, J. Davidson3, M. Lee 2, T. Wang1
1
Adult Emergency department, 2Greenlane Cardiovascular Service, 3 Laboratory Services, Auckland City
Hospital.
Introduction: hsTnT was introduced prior to determination of the optimal clinically useful cutoff to detect
AMI. Roche have suggested a cutoff of 53ng/L, based on the intersection of a regression line of hsTnT
values plotted against cTnT, where cTnT 30ng/L ≈ hsTnT 53ng/L.
Aim: to validate the cutoff and to explore the optimal cutoff for hsTnT based on clinical grounds.
Methods: 161 patients were tested with both cTnT and hsTnT. There were 31 AMIs (19%). The
relationship between the assays determined. The sensitivity, specificity and likelihood ratios of the tests
were compared and the areas under the Receiver-Operator Curve (ROC AUC) were used to determine the
overall difference between assays.
Results: When cTnT was ‘undetectable’ there were a wide range of values for hsTnT (3-46ng/L, mean (SD)
= 9.4 (7.8) ng/L. For cTnT in the range 10—100ng/L, there was a linear relationship: R 2 = 0.85. At cTnT
30ng/L, hsTnT was 45ng/L. For detecting AMI, hsTnT 42ng/L was closest to cTnT 30ng/L, sensitivity 81% vs
84% respectively, with specificity 92% for both. At 53ng/L, hsTnT was less sensitive (77%), but more
specific (96%). No single cutoff provided both optimal rule-in and rule-out properties. ROC AUCs for hsTnT
and cTnT were 0.953 and 0.914.
Conclusion: The optimal clinically relevant cut-off for hsTnT depends on whether one wants to use the
test to rule in or rule out AMI. Tests should only be requested, and results interpreted, after consideration
of the clinical context.
14
21. PREVALENCE OF ACCESS BLOCK IN NZ EMERGENCY DEPARTMENTS IN 2010 AND THE EFFECT ON THE
SHORTER STAYS IN ED TARGET
P. Jones1, S. Olsen2
1
Adult Emergency department, Auckland City Hospital. 2Emergency Department, North Shore Hospital
Introduction: ‘Access Block’ for hospital admission from an ED is defined as a wait for an inpatient bed > 8
hours and is associated with increased mortality. We aimed to describe the prevalence of access block in
NZ EDs and to determine whether this impacted on the Shorter Stays in ED Target (SSED).
Methods: Surveys of all NZ ED on Monday 31 st May 2010 and 30th August at 10:00 hours were conducted
Data collected included number of patients, current bed occupancy, degree of access block and target
performance. The relationship between success in the SSED target and presence of access block and ED
occupancy was explored using cross-tabular statistics.
Results: In May compared to August, the number under treatment was 353 vs 390 (p=0.33), and 337/610
(55%) vs 335/619 (54%) of available beds were occupied (p=0.65), with 136 vs 155 waiting to be seen
(p=0.27) and 61 (16%) vs 81 (20%) waiting for admission (p=0.18). Of these, 25 (45.5%) vs 59 (79.7%) were
waiting >8hr (p=0.04). Access block was seen more in tertiary than secondary hospitals (50% vs 8.3%,
p=0.036) in May and 50% vs 25% (p=0.25) in August. Access Block was associated with failure to achieve
the SSED target in both May (p=0.02) and August (p=0.05), whereas ED Occupancy was not (p=1.0 and
0.59 respectively).
Conclusion: Access block continues to be a problem in tertiary hospitals in NZ and contributes significantly
to the inability to of these hospitals to meet the ‘Shorter Stays in ED’ target.
22. VALIDATION OF A TOOL TO PREDICT EMERGENCY DEPARTMENT LENGTH OF STAY
P. Jones1, A. Peterson2
1
Adult Emergency Department, Auckland City Hospital, 2Central Projects Office, Auckland City Hospital.
Introduction: Emergency Department (ED) Length of Stay (LOS) is one of the key quality indicators for
hospital performance. Modelling the distribution of ED LOS in one centre in the UK suggested that
average ED LOS may predict the change in performance required to meet the ED LOS target, using a
simple tool.
Aim: To validate the tool and to determine whether the tool was useful in our setting.
Methods: EDLOS was recorded from 2006-2010, during which time the ‘95% in six hour’ EDLOS target was
introduced. The distribution of EDLOS was compared to the UK model, and the ability of the model to
predict our EDLOS was calculated.
Results: The distribution of our data most closely approximated the generalised hyperbolic distribution.
This was different to the hypoexponential distribution used to derive the tool. In 2008 our average ED LOS
was 6.3 hours, and 68% of patients were discharged from the ED within 6 hours. The tool predicted
approximately 65%. In order to meet the NZ EDLOS target, we would need to reduce our average LOS to
approximately 2.0 hours.
Conclusion: Despite the distribution of ED LOS in our hospital being different to that used to develop the
predictive tool, the tool was still useful in our setting. To achieve the six hour target of 95%, our hospital
should direct resources towards reducing the LOS of those patients who stay the longest.
15
23. SNAPSHOT OF ETHNICITY IN AUCKLAND MEDICAL ONCOLOGY CLINICAL TRIALS
S. Ko
There is a lack of published data on Maori and other ethnic groups participating in clinical trials.
Disparities in the healthcare interventions received by ethnic groups are often of interest, particularly in
the case of the Maori population in New Zealand. The aim of this study was to provide a snapshot of the
ethnicity of patients participating in medical oncology clinical trials in the Auckland (and Northland)
regions of New Zealand.
Comparisons of interest were with the ethnicity percentages obtained from the 2006 New Zealand Census
and the incidence of breast cancer by ethnicity in New Zealand.
24. EVALUATION OF CANDIDATE GENES IN PATIENTS WITH COMMON VARIABLE IMMUNODEFICIENCY
W. Koopmans¹, S.-T. Woon², P. Browett ¹, R. Ameratunga¹,²
1
Department of Molecular Medicine and Pathology, University of Auckland, New Zealand
2
Department of Virology & Immunology, LabPLUS, Auckland City Hospital, Auckland, New Zealand
Common variable immunodeficiency (CVID) is a frequent primary immunodeficiency disorder with
approximately 1/25,000 incidence rate. In about 25% of cases a familial inheritance is observed but most
cases are sporadic. CVID is a heterogeneous disease with an increased susceptibility to infections of the
respiratory and gastrointestinal tracts with encapsulated bacteria. Four monogenic defects correlated to
CVID have been identified and other genetic defects producing the same phenotype will likely be
identified. We screened 95 patients with CVID or hypogammaglobulinemia for mutations in ten genes:
three known disease-causing genes and seven candidate genes. The seven candidate genes were selected
based on mouse studies that produce a phenotype similar to human CVID. We found four different TACI
mutations in this group of patients (R20H, C104R, A181E and R202H). R20H mutation is of unknown
clinical significance but C104R, A181E and R202H have been described previously. Three unrelated
patients were found with a heterozygous C104R mutation and all three patients show different
symptoms. The significance of these mutations will be evaluated by segregration studies in families with
these mutations.
WK is supported by the University of Auckland International Doctoral Scholarship, Immunodeficiency
Foundation of NZ, Australasian Society of Clinical Immunology and Allergy, Octapharma, and LabPlus.
25. PROSTHETIC HIP RELOCATION IN THE EMERGENCY DEPARTMENT AND OPERATING THEATRES OF
AUCKLAND CITY HOSPITAL
E. Lawrey1, P.Jones1
1
Adult Emergency Department, Auckland City Hospital
This retrospective study compared prosthetic hip relocations (PHR) attempted in the emergency
department (ED) by ED staff and those by orthopaedic staff either in ED or in operating theatre (OT).
Participants: Patients presenting with prosthetic hip dislocations 01/01/2003 – 14/04/2008.
Results:
409 separate admissions of 193 patients were eligible. 323 (79%) had a reduction attempt
by ED in ED, 35 (9%) were by orthopaedics in ED and 51 were by orthopaedics in OT (12%). Orthopaedic
patients were 3.7 years younger than ED patients (71.3 vs 75yrs, p=0.024). ED success was 79% (74-83%)
and orthopaedic was 74% (55-84%) in ED (p=0.45) and 96% in OT (86-100%). Median time (IQR) to first
relocation was 135min (95.3-98.8) for ED, 179 min (110-255) for orthopaedics in ED and 320 min (227410) for orthopaedics in OT (p<0.001) and the hospital LOS was 8.8 (5.2-26.1), 28.3 (16.4-28.3) and 81
(32.8-287.2) hrs respectively (p<0.001). 3.7% (2-7%) and 3.5% (1-10%) of ED and orthopaedic-treated
16
patients represented within 48hrs of discharge (p=0.62). Complications of the procedure were 14 (1118%) and 13.9% (8-22%) respectively (p=0.89), and sedation complications were 15% (12-20%) in ED and
62% (48-74%) in OT (p<0.0001).
Conclusion: PHR was equally successful regardless of specialty. ED was safer than OT for sedation. In ED
patients waited less time for their procedure and stayed in hospital for significantly less time.
26. DIAGNOSTIC AND STAGING EFFICACY OF EBUS-TBNA PERFORMED UNDER CONSCIOUS SEDATION IN
SUSPECTED THORACIC MALIGNANCY
C.A, Lewis, S. De Boer, T. I. Christmas, M. R. O’Carroll
Respiratory Services, Auckland District Health Board, Auckland, New Zealand
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a highly sensitive
diagnostic and staging method in thoracic malignancy. Many prior reported series have performed EBUSTBNA under general anaesthesia (GA) with prior CT-PET. We report data from our new EBUS service in
Auckland, where conscious sedation is utilized and CT PET has very limited availability.
Cases referred for EBUS for suspected intrathoracic malignancy were included, performed between
November 2007 and June 2010. EBUS-TBNA was compared with further diagnostic and staging
investigations, and resection specimens where available; if not, the clinical course over the following 6
months was used to assign EBUS result accuracy.
127 cases were performed. Mean (sd) sedation doses used were fentanyl 101.8 (23.1) mcg and
midazolam 2.1 (0.7) mg. Number of passes for the first and second nodes sampled (if applicable) were 3.1
(1.2) and 1.8 (1.0) respectively. 14 cases were classified as false-negative (FN), 31 as true negative (TN),
74 as true positive (TP); 1 was not able to be classified (U) and in 7, no TBNA was performed. In 3 of 14 FN
cases, intolerance was reported. The sensitivity of EBUS-TBNA for malignancy was thus 84.1%. Sensitivity
for procedures performed in the last 12 months of the period was 88.6%.
EBUS-TBNA under conscious sedation yields comparable results with EBUS-TBNA under GA. The
diagnostic accuracy of the procedure appears to improve with experience.
17
27. ACUTE CORONARY SYNDROME PATIENTS TREATED WITH CORONARY ARTERY BYPASS SURGERY
HAVE POOR CHOLESTEROL CONTROL AND SIGNIFICANT ADVERSE EVENTS AT REVIEW 3 YEARS LATER
18
28. ACUTE CORONARY SYNDROME PATIENTS TREATED WITH PERCUTANEOUS CORONARY
INTERVENTION: POTENTIAL FOR SIGNIFICANT SOCIO-ECONOMIC BURDEN FROM ADVERSE EVENTS DUE
TO POOR CHOLESTEROL CONTROL AT REVIEW 3 YEARS LATER
C.Y. Lin*1, A. Lin 2, J.L. Looi, K.L. Looi, K.L. Chow, S. Haliday, M. Lee, H.D. White, C.J. Ellis
1,2
Green Lane Cardiovascular Service, Auckland City Hospital, Auckland.
Background: Acute Coronary Syndrome (ACS) patients (pts) treated with percutaneous coronary
intervention (PCI) are at significant risk for future Major Adverse Cardiovascular Events (MACE). Young
PCI pts have many life-years to potentially lose from subsequent MACE. Aggressive lowering of LDL
cholesterol (LDL-C) to <2.0 mmol/L (NZ Guidelines Group) or ≤1.6 mmol/L (TIMI-22 study and Green Lane
CVS target) reduces MACE. We assessed LDL-C control of pts from Auckland City Hospital.
Methods: Using a prospective database of all pts admitted to ACH Coronary Care Unit (CCU), we reviewed
clinical records for current patient data.
Results: From 1/6/2006 to 31/7/2007, 901 pts were admitted to CCU with ACS, 434 pts received inpatient
PCI. At a median follow up time of 2.8 [IQR 2.5-3.3] years, 408 pts had undergone recent blood tests and
were available for information on current status. 99 (24%) pts had a LDL-C level ≤1.6 mmol/L. 166 (41%)
had LDL-C <2.0 mmol/L. There were a total of 175 MACE including 30 deaths.
Target LDL cholesterol ≤ 1.6 mmol/L
Target LDL cholesterol < 2.0 mmol/L
41%
24%
LDL ≤1.6 mmol/L
LDL>1.6mmol/L
LDL<2mmol/L
LDL≥2mmol/L
76%
59%
In 2006-2008, the New Zealand life-expectancy was 78 years (men) and 82 years (women). In our ACS PCI
cohort the mean ages were 59 ±13 years (men) and 69 ±12 years (women).
Conclusion: The potential socio-economic burden resultant on poor cholesterol control is starkly
suggested by this cohort review.
29. PREOPERATIVE MRI ASSESSMENT OF DEPTH OF MYOMETRIAL INVASION IN ENDOMETRIAL CANCER
S. Lin
Gynaecological Oncology Department, Auckland City Hospital
Objectives: Assessment of myometrial invasion (MI) by magnetic resonance imaging (MRI) is being used
to triage patients with low grade endometrioid adenocarcinoma of the endometrium. Patients with <50%
MI are operated on by general gynaecologists and those with >50% are offered staging in the gynaecology
oncology unit. We were keen to evaluate the accuracy of preoperative MRI in assessment of MI.
Methods: Patients with Grade 1 and 2 endometrioid adenocarcinoma who underwent hysterectomy in
2009 in Auckland were included, n= 50. MRI was performed pre-operatively and the depth of MI was
19
assessed as either <50% or >50%. The MRI prediction of the depth of MI by referring radiologists and
MDM radiologists were compared. Histological evaluation was compared to MRI.
Results: Histological evaluation revealed that 41 patients had <50% invasion, and 9 patients had >50%
invasion. On MRI assessment by the referring radiologist, 46 patients had correct diagnosis of depth of MI;
the sensitivity, specificity, and accuracy were 78%, 95%, and 92% respectively. On the MRI assessment by
the MDM radiologists, 43 patients had correct diagnosis; the sensitivity, specificity and accuracy were
78%, 90% and 88% respectively.
Conclusion: Preoperative MRI assessment has good correlation to final histology. There is no difference
between MRI assessments by radiologists at referral centres compared to our unit’s radiologists. The
patients’ care pathway may be streamlined by eliminating the need for a secondary review at the MDM.
30. HIGH MORTALITY AND MORBIDITY IN ACUTE CORONARY SYNDROME PATIENTS WHO RECEIVED
MEDICAL (NON-REVASCULARISATION) MANAGEMENT
J.L. Looi*1, K.L. Looi 1, K.L. Chow 1, S. Haliday 1, M. Lee 1, G. Gamble 2, H.D. White 1, C.J. Ellis 1
1
Green Lane Cardiovascular Service, Auckland City Hospital, Auckland. 2 Dept of Medicine, Auckland
University, Auckland.
Background: Revascularisation with percutaneous coronary interventions (PCI) or coronary artery bypass
grafting (CABG) is effective in reducing morbidity and mortality in patients (pts) with acute coronary
syndrome (ACS). However, some pts are managed medically only.
Methods: Using a prospective database we analysed 628 ACS admissions from the ACH catchment area.
Results: 260 pts were medically managed after an ACS. 179 patients underwent coronary angiography.
Of those, 109 had normal, mild/single vessel disease. 70 patients (mean age 70.4+11.5 years) had severe
disease (≥75% in ≥2 vessels). Pts without angiogram were older (mean age 79.7 years, p<0.001). Renal
dysfunction was common in both groups (baseline creatinine 158 umol/L and 185umol/L respectively).
For patients not receiving angiography (81) or with severe disease (70) not receiving revascularisation
(total n=151), outcomes were poor at median follow-up 1.73 (0.26 – 2.83) years with 205 major adverse
cardiac events (MACE): 30 cardiac deaths, 32 heart failure admission, 66 cardiac chest pain admission and
40 subsequent ACS (see Figure). 14 later had revascularisation (9PCI and 5 CABG).
20
Conclusion: ACS pts treated medically with either severe coronary disease or not offered angiography
have significant MACE at medium-term follow-up. Options for revascularisation in this group may be
limited due to underlying comorbidities, but understanding of the poor outcome if managed medically
may be helpful in determining management.
21
31. ACUTE CORONARY SYNDROME PATIENTS TREATED WITH CABG SURGERY: SUBOPTIMAL USE OF
SECONDARY PREVENTION MEDICATIONS AT REVIEW 3 YEARS LATER
22
32. MEASUREMENT OF SERUM RIFAMPICIN BY HIGH-PERFORMANCE LIQUID CHROMATOGRAPHY WITH
ULTRAVIOLET DETECTION. SAMPLE PREPARATION AND STABILITY CONSIDERATIONS
G. Woollard, H. Madhavaram, W. Chiu
Department of Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand
Introduction: Rifampicin (3-(4-Methyl-1-piperazinyliminomethyl)rifamycin SV) is a semisynthetic
antibiotic used in the treatment of tuberculosis in combination with other drugs. Therapeutic drug
monitoring of rifampicin can be useful for patients with poor treatment response, suspected noncompliance and malabsorption. We developed an HPLC-UV method to assay serum rifampicin.
Methods: The stability of rifampicin is well known to be a problem. Serum and plasma aliquots were
measured repeatedly for the first few hours and thereafter until 24 hours. Sample preparation was by
simple protein precipitation. Several organic solvents were tested and the stabilities of the resulting
extracts were examined. The extracts were chromatographed on a Phenomenex Prodigy ODS3 column
and monitored by photodiode array detection at 334nm wavelength. Results from the HPLC method and
our existing spectrophotometric method were compared.
Results: Serum and plasma rifampicin stored at room temperature, 4oC or -20oC showed no deterioration
until at least 24hours, 1week and 3months respectively. Specimens precipitated with acetonitrile were
stable for at least 24 hours at room temperature. Extracts in methanol or 50% acetonitrile/methanol
mixtures are far less stable. The deterioration rate in methanolic solutions is too fast to be of use despite
being utilised in several published rifampicin methods.
Comparison of HPLC vs. spectrophotometric method (n=14) revealed slope of 0.9994, r 2 = 0.9447
Conclusion: This HPLC-UV assay is a robust method for the measurement of serum or plasma rifampicin.
33. CHILD AND FAMILY EXPERIENCES OF PAEDIATRIC RHEUMATOLOGY CARE IN NEW ZEALAND
H. Mato, J. Blamires, A. Sorhage, J. Yan, P. Campbell Stokes, R. Callear, M. Downs Smith, S. Rudge
Aim: A national Paediatric Rheumatology Service was established in 2009. To establish the needs of the
patients and caregivers and identify particular areas of service development a service satisfaction survey
was developed.
Methods: The survey included 21 questions with 5 subsections: contact and appointments; education;
practical support; staff members and overall service satisfaction. A five point Likert item (1 = excellent, 5=
poor) was used with the child or caregiver asked to rate their answers to each question.
Results: 142 surveys were completed by 79 parents and 63 children over the age of 10 years who
attended paediatric rheumatology clinics over a 3 month period. Mean age of patients was 12.4 years;
57% of which were female; 41% surveyed had disease duration of >3yrs. 65% had seen a physiotherapist,
25% a rheumatology nurse specialist , 14% and occupational therapist and 20% had never seen an allied
health professional.
The average score for contacts and appointments was 1.9. Education averaged 1.9. Practical support
scored 2.2. Staff members scored 1.6 with all respondents rating between ok-excellent.
Conclusion: Overall there was a high level of satisfaction with Paediatric Rheumatology services. The
survey identified key areas for service development, particularly improving access to multidisciplinary
team members, providing school information and preparing for transition. Strategies have been
implemented to address these and the survey will be repeated annually to assess progress.
23
34. HUMIDIFICATION OF LOW FLOW OXYGEN THERAPY FOR INFANTS AND YOUNG CHILDREN. PILOT
STUDY REPORT
L.-C. Whelan1 , Elaine McCall2
1
Staff Nurse, 2Clinical Nurse Consultant, Paediatric Intensive Care Unit, Starship Children’s Hospital
Background: The need for supplemental oxygen due to an acute respiratory illness is a common cause of
hospital admissions in the paediatric population. Presently low flow oxygen can be delivered either as a
dry gas or a heated humidified gas but there is little evidence about which mode of delivery is most
beneficial to paediatric patients.
Methods: A prospective randomised controlled study was undertaken. Following consent from the parent
or legal guardian, children were randomised to receive either (i) heated humidified oxygen via a Fisher
and Paykel heated humidifier, circuit and nasal cannula or (ii) oxygen as per existing Starship practice. The
oxygen flow rate for both groups was prescribed by medical staff and weaning of oxygen was undertaken
as per Starship clinical guidelines. The primary outcome measure was total hours on oxygen therapy and
length of hospital stay.
Results: There was no significant statistical difference identified between the two modalities, however
there was a trend towards less time on oxygen therapy and reduced time to ready/actual time of
discharge for the humidified group.
Conclusion: A larger multicentre study would be required to detect any statistical difference. The Starship
Recommended Best Practice has been revised in light of the results.
35. ADEQUACY OF INFORMATION GIVEN TO PATIENTS WITHIN THE SPEECH LANGUAGE THERAPY (SLT)
SERVICE: A PATIENT AND CARER PERSPECTIVE
B. McCormack, B. Kerr, C. McCann
Background: An audit was carried out at ACH to determine the current information provision for patients
and carers who received SLT services.
Methods & Procedures: 30 participants (19 patients, 11 carers/family members) took part in a single
semi-structured interview using total communication techniques. Participants rated information received
on a variety of topics. Medical notes were also audited.
Outcomes & Results: All participants indicated they had received some form of information, solely oral
information provision was indicated by 73.3%. 40% of participants could not identify when they had
received information but 73.3% stated it had been repeated. All participants rated information provision
about general topic areas as below average. Information about risk reduction was rated significantly
below the other topics (p<0.05). Information from the SLT about communication was rated significantly
better than information about dysphagia (p=0.032). Rating scores negatively correlated with the length of
time a patient had been in hospital. Participants commented mainly around a need for further written
information and more information generally.
Conclusion: Whilst all participants received patient information, its content was rated poorly in the study.
Patient information about diet modifications needs to be developed, and SLTs need to routinely provide
more information about all areas from diagnosis to discharge.
36. PSYCHOLOGICAL WELL-BEING OF ADOLESCENT SURVIVORS OF CHILDHOOD CANCER IN NEW
ZEALAND: A NATIONWIDE STUDY
H. McDowell, Senior Clinical Psychologist 1,2, Kathy Yallop Nurse Specialist 1, Simon Denny, Specialist Youth
24
Physician 2, Peter W Reed, Biostatistician 1
1
Starship Children’s Health; 2 University of Auckland
Paediatric consult liaison team, New Zealand
Purpose: There is no published research on the psycho-social well-being of adolescent survivors of
childhood cancer in NZ. The nation-wide Adolescent Childhood cancer Survivors Impact Study (ACSIS) was
designed to gather information on the psycho-social well-being of this population..
Methods: The ACSIS study used an internet-based branching questionnaire. The Youth2007 (normative
sample of 9,100 NZ adolescents aged 12 - 18 years ) participants provide the control group. The ACSIS
questionnaire was adapted from the Youth2007 questionnaire in collaboration with the Youth2007
research team. Participants in both studies were anonymous. Psychological well-being was assessed using
the standardized measures RADS-2 SF; MASC-10; SDQ, and WHO-5. A national health database was used
to identify all potential participants for the ACSIS study. 48% eligible (12-18 years of age; cognitive and
language ability to understand and answer the questionnaire) and invited to participate, did so.
Results: Preliminary results on the standardised measures of psychological well-being, and their
comparison
with
the
Youth2007
control
group
data,
will
be
presented.
Conclusion: This study is unique in terms of being a nationwide NZ study and having comparison (control
group) data from such a large, normative sample. The findings of this research will make a significant
contribution to our understanding of the well-being and needs of this population and provide a sound
basis for the development of service initiatives from diagnosis to late effects monitoring.
37. DETECTING ACUTE NEUROTOXICITY DURING PLATINUM CHEMOTHERAPY BY NEUROPHYSIOLOGICAL
ASSESSMENT OF MOTOR NERVE HYPEREXCITABILITY
A. Hill, P. Bergin, F. Hanning, P. Thompson, M. Findlay, D. Damianovich, M. J. McKeage
Departments of Medical Oncology and Neurophysiology, Auckland City Hospital, and Cancer Clinical
Pharmacology Research Group, School of Medical Sciences, University of Auckland, Auckland, New
Zealand
Background: Platinum-based drugs, such as cisplatin and oxaliplatin, are well-known for inducing chronic
sensory neuropathies but their acute and motor neurotoxicities are less well characterised. We assessed
motor nerve excitability in cancer patients during their first treatment cycle with platinum-based
chemotherapy.
Methods: 29 adult cancer patients had a neurophysiological assessment either before oxaliplatin plus
capecitabine, on days 2 to 4 or 14 to 20 after oxaliplatin plus capecitabine, or on days 2 to 4 after
carboplatin plus paclitaxel or cisplatin, by a neurophysiologist blinded to the conditions. Patients
completed a symptom questionnaire at the end of the treatment cycle.
Results: Abnormal spontaneous high frequency motor fibre action potentials were detected in 100% of
patients (n=6) and 72% of muscles (n=22) on days 2 to 4 post-oxaliplatin, and in 25% of patients (n=8) and
13% of muscles (n=32) on days 14 to 20 post-oxaliplatin, but in none of the patients (n=14) or muscles
(n=56) tested prior to oxaliplatin or on days 2 to 4 after carboplatin plus paclitaxel or cisplatin. Repetitive
compound motor action potentials were less sensitive and less specific than spontaneous high frequency
motor fibre action potentials for detection of acute oxaliplatin-induced motor nerve hyperexcitability.
Acute neurotoxicity symptoms were reported by all patients treated with oxaliplatin (n=22) and none of
those treated with carboplatin plus paclitaxel or cisplatin (n=6).
Conclusion: Abnormal spontaneous high frequency motor fibre activity is a sensitive and specific endpoint
of acute oxaliplatin-induced motor nerve hyperexcitability.
25
38. NISSEN FUNDOPLICATION POST LUNG TRANSPLANT: COMPLICATION RATES AND EFFECTS ON BOS
PREVALENCE
C. Lewis1, E. White2, J. Windsor3, M. O’Carroll1, K. Whyte1, T. McWilliams1.
1
NZ Heart and Lung Transplant Service and 2Lung Function Laboratory, Auckland District Health Board;
3
Department of General Surgery, University of Auckland, Auckland, New Zealand
Gastro-oesophageal reflux (GERD) post lung transplant (LTX) has a reported association with bronchiolitis
obliterans syndrome (BOS), and it has been suggested that Nissen fundoplication (NF) can attenuate or
even reverse BOS.
Aim: Prospective audit of NF carried out in lung transplant recipients at our centre. NF was carried out
both for specific indications and following routine post LTX screening for GERD, commenced in October
2007.
Methods: Data collection included demographics, lung function, indication for NF, surgical complications
and outcome, weight changes, lung function and prevalence of BOS pre and post NF.
Results: The first NF was performed in March 2007. Fourteen patients (6 males, all BSLT, 8 for COPD, 4
for CF) have undergone NF, all performed by one experienced surgeon (JW). Indications were established
BOS (n=1), early BOS (n=3), recurrent infection (n=1), recurrent acute rejection (n=1) or reflux on pH
probe (n=8).
There was one intra-operative complication and two significant post-operative
complications (NF failure n=1, disruption of crural repair n=1). Eleven patients reported dysphagia within
three months, but only one for longer. Mean weight loss was 7.8% (range 0 to 38%). To date, only 2
patients have developed BOS (stages 0p and 3) following NF.
Conclusion: NF is a safe procedure post LTX with an acceptable complication rate.
prevalence is low to date.
Post-op BOS
39. IDENTIFYING ASPIRATION AND REDUCING PNEUMONIA IN STROKE PATIENTS USING COUGH REFLEX
TESTING
A. Miles1, H. McLauchlan2, M-L. Huckabee PhD3
1
University of Auckland, Auckland/ University of Canterbury, Christchurch, NZ/ Auckland City Hospital,
Auckland District Health Board, Auckland; 2Middlemore Hospital, Counties Manukau District Health Board,
Auckland, NZ; 3Dept. of Communication Disorders, University of Canterbury, Christchurch, NZ/ The Van
der Veer Institute for Parkinson’s and Brain Research, Christchurch, NZ
Significant health issues and costs are associated with post stroke pneumonia related to dysphagia.
Traditionally a speech-language therapist performs a clinical swallowing evaluation on people following a
stroke but this is not reliable for identifying silent aspiration. The literature suggests that a cough reflex test
may be reliable for discriminating patients with impaired and intact cough responses and thus may have the
potential to decrease pneumonia rates in patients with neurological impairment.
Stroke patients referred for a swallowing evaluation at four New Zealand hospitals are being approached
for participation in the study. The study aims to recruit 300 participants. Consenting participants are
randomly assigned to either a 1) standard evaluation group or 2) standard evaluation with inclusion of
cough reflex testing. For those in the experimental group, concentrations of inhaled, nebulised citric acid
are being administered to assess cough response. Results of the cough reflex test will contribute to multidisciplinary clinical decision-making.
Outcomes will be measured by pneumonia rates at 3 months. If successful in reducing morbidities, this
test can be easily implemented by clinicians without significant cost and consequently lead to early
identification of those at risk of developing aspiration pneumonia.
26
This clinical trial has been successfully recruiting participants since March 2010. Final data analysis is not
available as yet.
40. THE AUCKLAND BREAST CANCER REGISTER
P. Murray
The Auckland Breast Cancer Register (ABCR) was established by the Auckland Breast Cancer Study Group
(ABCSG) against a background of important advances in all areas of breast cancer. Information about
current practice plays a key role in supporting the multidisciplinary teams necessary for modern, high
quality, evidence-based care. In order to supply this information, the ABCSG recognised the need for a
comprehensive database designed to assist with the ongoing management, research and audit of breast
cancer. As a result, the ABCR was established on 1 June 2000 after approval was granted by the Northern
Ethics Committee. Before data are included in the register, patients are requested by their clinicians to
sign a consent form. Confidentiality of data is maintained at all times and only de-identified data is ever
extracted from the register. Between 1 June 2000 and 31 May 2008 a total of 6406 patients were
diagnosed with breast cancer within the Auckland region. Of these, 91% consented to their details being
included in the register (excluding 164 who died before consenting). The data for these 5698 patients,
representing 5811 incidents of breast cancer, are presented in the statistics poster. Data to date for
demographics, diagnosis, prognostic indicators and treatment are mostly consistent with national and
international reports.
41. AUDIT OF APHASIA THERAPY AND THE ICF
J. Oberst, Practice Supervisor – SLT,
Rehab Plus, Carrington Rd, Point Chevalier, ADHB
Background: Preferred practice guidelines for SLTs are based strongly on the principles of the World
Health Organizations’ ICF. Expert opinion and case studies have contributed significantly to a change in
best practices, and standards for aphasia therapy at Rehab Plus were developed to reflect this change in
thinking.
Audit Methods: This audit sampled the last 10 consecutive patient files of discharged patients who had a
diagnosis of aphasia. Five files were selected from the Rehab Plus outpatient department and five from
the Rehab plus inpatient wards. Any entry marked with a speech and language therapy sticker in these
files was audited to ensure that the entire patient journey was considered.
Results: In relation to the standards for aphasia therapy results show that although we are addressing all
components of the ICF in therapy, there is too much emphasis on tasks aimed at the body structure and
function level, particularly in the outpatient setting.
The poster will discuss results in further detail and consider limitations of the audit.
Recommendation: Audit results were discussed at a team planning day, and a plan to address problems
areas was developed. The Audit will be repeated December 2010 to determine whether services have
changed.
42. EPIDEMIOLOGY OF INVASIVE FUNGAL INFECTIONS IN AT RISK HAEMATOLOGY PATIENTS IN
AUCKLAND CITY HOSPITAL (2006 – AUG 2010)
R. Palanicawandar
Invasive fungal infections are an important cause of death in patients undergoing treatment for leukemia.
The incidence of invasive fungal infection in leukemia and stem cell transplant patients treated at
Auckland City Hospital was unknown.
27
The leukemia database was established to collect this data in a prospective fashion from 2008.
Retrospective data was collected from 2006 to 2008. The incidence of probable or proven invasive fungal
infection in acute myeloid leukemia patients undergoing induction chemotherapy, acute lymphoblastic
leukemia and patients undergoing allogeneic stem cell transplant was 13%, 8% and <1% respectively. In
patients treated for AML , there were 4 deaths due to mold (aspergillus or zygomycetes) infection giving a
mold attributable death rate of 31%
Current anti-fungal prophylaxis with fluconazole does not protect patients at risk from IFD with
aspergillus or zygomycetes. Voriconazole would offer prohlyaxis against aspergillus but not zygomycetes.
Posaconazole offers protection against both and is being investigated as primary prophylzxis for patients
undergoing intensive therapy for AML. Knowledge of the local incidence of fungal infections and the
causative agent is critical for making informed decisions in antifungal policy.
43. DOES EXPRESSION OF THE GASTRIC MUCIN MUC6 HELP IDENTIFY ADVANCED SERRATED
COLORECTAL POLYPS?
S. Parry*, M. Walsh, S-A. Pearson, D. Buchanan, R. Walters, K. Sweet, A. de la Chapelle, N. Walker, J.
Young.
NZ Familial Gastrointestinal Cancer Registry, Auckland City Hospitals.
Recently, expression of MUC6, was found to correlate with 100% specificity with sessile serrated
adenomas (SSA) a lesion thought to be an important precursor of colorectal cancer.
Our aim was to explore this finding in a series of patients with hyperplastic polyposis syndrome (HPS), a
condition associated with the development of multiple serrated polyps and lesser numbers of adenomas.
Nine cancers and ninety-three polyps (39 common hyperplastic polyps (HP), 35 advanced serrated polyps
comprising 27 SSA, 1 serrated adenoma (SA) and 7 mixed polyps (MP), and 19 traditional adenomas (TA))
from 31 patients were stained for MUC6. Staining was positive in 69% of SSA, 86% of MP, and negative in
a single SA. Overall, staining was positive in 70% of advanced serrated polyps which was significantly
greater than the level seen in common HP (38%; P=0.0065). Four of nine CRC (44%) stained positive for
MUC6 and 75% of these were proximal contrasting with 20% of distal CRC. More proximal serrated
polyps stained positively for MUC6 than distal serrated polyps, 66% and 30% respectively (P=0.008).
MUC6 is frequently expressed in SSAs and to a lesser extent in HP and therefore does not provide a
surrogate marker for advanced morphology in serrated polyps. The correlation of MUC6 expression with
proximal location may suggest that a subset of common serrated polyps in the proximal colon may be
developmentally related to their more advanced counterparts.
44. EXTENT OF BOWEL RESECTION IN YOUNG PATIENTS WITH COLORECTAL CANCER (CRC): WHAT IS
HAPPENING?
D. Wright1, G. Willdridge1, B. Parry2, I. Bissett2, S. Parry1
New Zealand Familial Gastrointestinal Cancer Registry (NZFGCR)1, University of Auckland2, Auckland, New
Zealand
Introduction: In Auckland, most young patients with CRC are managed in specialised Colorectal Units.
Such patients are discussed in Multi-disciplinary Meetings, the possibility of hereditary syndromes
discussed, and are referred to the NZFGCR for evaluation and advice. Undertaking extended bowel
resections in this group is a contentious issue balancing the reduced risk thereby of metachronous
tumours versus the possibility of poorer functional results.
Aim: To review the practice of colorectal surgeons in Auckland for undertaking extended resections of
patients aged 50 years or younger with CRC.
28
Methods: Retrospective review of a prospectively collected database of young patients with CRC was
undertaken for the period 2001 to 2007. The type of and reason for each operation were recorded.
Results: Of 238 patients identified, 69 had R. sided, 167 L. sided, and 2 had synchronous L. and R. sided
tumours. Total or subtotal colectomy was done in 5 (7%) cases of R. sided tumours (including with 2
metachronous, 1 JPS, 1 UC), 11 (7%) in those with L. sided tumours (including 5 obstructed, 3 with known
HNPCC), and in both 2 of the synchronous tumour cases.
Conclusion: Colorectal surgeons in Auckland are conservative about the extent of resection undertaken in
young CRC patients. Previous resections, obstruction, and extent of the disease are the main
determinants. Currently a suspected or confirmed germline mutation has little impact on the decision.
45. MISMATCH REPAIR GENE PROTEIN EXPRESSION IN YOUNG PATIENTS WITH COLORECTAL CANCER:
THE EIGHT YEAR AUCKLAND EXPERIENCE
D. Wright^, J. Arnold^&, B. Parry^, I. Bissett^, K. Y. Chau^, K. Wong*, M. Hulme-Moir #, S. Parry*^&
Auckland City Hospital^, Middlemore Hospital*, North Shore Hospital #; NZ Familial Gastrointestinal
Cancer Registry&
Introduction: Since 2001 the three public hospitals in Auckland have had the policy of undertaking
immunohistochemistry (IHC) testing on tumours of patients aged 50 years and under to detect loss of
expression (LOE) of protein products for the mismatch repair (MMR) genes MLH1, MSH2, MSH6 and
PMS2.
Aim: To determine (1) the completeness of patient capture (2) appropriate referral to genetic services for
patients identified to have LOE for one or more of the MMR proteins (3) the percentage of these with
germline mutations.
Methods: Retrospective review of the prospectively gathered clinical, pathological, and genetic records of
all patients diagnosed with CRC aged 50 years and below between January 2001 and December 2007.
Results: 245 patients aged 50 years or below with CRC were diagnosed in this period. 212 (86.9%)
patients’ tumours underwent IHC, 147 of which had all 4 gene products studied. LOE was identified in 30
patients, 25 of whom were referred to genetic services. Three subsequently declined genetic testing. So
far 8 out of 16 patients tested have had a confirmed germline mutation. Only 3 of the 8 patients reported
a family history of CRC.
Conclusion: Tumour IHC reveals LOE for one of the four MMR gene proteins in approximately 14 % of
young patients developing CRC, and in half of these genetic testing will identify Lynch syndrome. A policy
of routine testing is therefore justified.
46. CARDIOVASCULAR MEDICATION USE FOLLOWING KIDNEY TRANSPLANT: DATA FROM THE PORT
INTERNATIONAL DATA COLLABORATION
H. Pilmore
Introduction: Cardiovascular Disease remains the most common cause of mortality and morbidity after
renal transplantation. Despite the high rates of cardiovascular events in renal transplant recipients, there
are few studies examining the effects of cardiovascular medications. The goal of this study was to
describe the use of cardiovascular medications during the first 5 years post-transplant.
Methods: The study population included all adult kidney transplant recipients with graft function 30 days
post-transplant from a subset of the 14 participating transplant centers. 10 of 14 centers provided data
on use of cardiovascular medications (N=14 236). Medication use was defined as using the medication at
any time during each 30-day period post-transplant.
29
Results: Beta-blockers and calcium channel blockers were the most commonly used antihypertensive
medications, with use in approximately 40% of the population during the first 5 years. Statin use
increased from 17% during the first 30 days to 39.6% at 5 years. The use of ACEIs/ARBs also increased to
36.3% at 3 years post-transplant after an initial drop from 15% to 12% during the first 3 months. The use
of other cardiovascular medications remained fairly stable.
Conclusion: Despite the high cardiovascular risk in the kidney transplant population, the use of
medications that have been shown to be beneficial in the general population at high cardiovascular risk
remains low.
50.0%
Beta-Blocker
45.0%
ACE/ARB
40.0%
35.0%
Antiplatelet
30.0%
Diuretic
25.0%
Other
Antihypertensive
CCB
20.0%
15.0%
10.0%
Statin
5.0%
0.0%
1 5 9 13 17 21 25 29 33 37 41 45 49 53 57
Other Lipid-Lowering
Agent
47. EVALUATION OF COBAS® 4800 TEST FOR HUMAN PAPILLOMA VIRUS (HPV) DETECTION AND
GENOTYPING IN CERVICAL SPECIMENS
F. Rahnama, K. Dullabh, S. Thomas, D. Williamson, K. Croxson
Department of Virology, Auckland Hospital, Auckland, New Zealand
Cervical cancer is the second most common cancer in women worldwide. In NZ, around 200 women are
diagnosed with cervical cancer annually, with approximately seventy deaths per year 2. Persistent genital
infection with oncogenic human papillomavirus(es) causes virtually all cases of cervical cancer 3,4. Over
forty different human papillomavirus (HPV) types are associated with genital infection; of these, certain
“high-risk” (HR) genotypes are closely associated with the development of cervical cancer. There are at
least 13 different HR HPV genotypes. Many studies have demonstrated that high-risk (HR) HPV testing is
more sensitive than cytology in the detection of cervical intraepithelial neoplasia lesion grade 2 (CIN 2)
and more severe lesions (CIN 2+)8. There is an increasing demand for a reliable method for extracting DNA
from clinical specimens in Liquid Based Cytology (LBC) media combined with high-throughput automated
detection for HPV. To meet these needs Roche has developed a new Cobas® 4800 HPV Test. This is an
automated system that performs sample preparation, real-time HR-HPV amplification and simultaneous
detection of 12 HR-HPV genotypes in a single pool, with separate detection of HPV16, HPV18 and the
human beta-globin gene. The linear Array test previously used in our laboratory, comprises amplification
of target DNA by PCR and nucleic acid hybridization and detects 37 anogenital HPV DNA genotypes and
the human beta-globin gene in cervical cells collected in PreservCyt® solution.
30
Objectives: To assess the assay agreement and the analytical detection of HR-HPV using the Cobas® 4800
HPV Test (c4800) versus the Linear Array (LA) kit.
48. CAUSE FOR CELEBRATION: INCREASED ADHERENCE WITH HAND HYGIENE RESULTS IN A BETTER
OUTCOME FOR PATIENTS WITHIN ADHB HOSPITALS
S. Roberts, T. Campbell, G. Balla, N. Buchanan, A. Keenan, S. Child, J. Mueller, C. Dennis, C. Morgan, L.
Hughes, S. Worboys
ADHB Steering Group for delivering of the ‘Hand Hygiene New Zealand’ programme
Background: Hand hygiene using alcohol-based hand rubs (ABHR) is the simplest and most effective
means of preventing healthcare-associated infections. Compliance rates amongst healthcare workers
(HCW) are traditionally poor.
Method: In May 2009 a multimodal behaviour change programme aimed at improving hand hygiene by
HCW was launched at ADHB. The programme developed by ‘Hand Hygiene New Zealand’ was based on
the WHO ‘5 moments for hand hygiene’ initiative. The programme involves the use of ABHR at the point
of care and auditing of compliance rates before and after implementation of the multimodal programme
with prompt feedback of compliance rates. Outcome measures were healthcare-associated
Staphylococcus aureus bloodstream and clinical infection rates.
Results: The average compliance rate amongst HCW at baseline was 35 %, and 4 months after
implementation the average compliance rate had increased to 62%. This improvement has been sustained
out to 12 months. Improvement was seen across all HCW groups. A decreasing trend in the healthcareassociated S. aureus bloodstream infection rates has been seen following the implementation of the
programme.
Conclusion: A multimodal behavioural change programme has resulted in improvement in hand hygiene
compliance across all HCW groups. With time, this should result in a further reduction in the rate of
healthcare-associated S. aureus bloodstream infections. An ongoing commitment is needed to sustain the
improvement in hand hygiene by HCW at ADHB.
49. MOLECULAR EPIDEMIOLOGY AND SUSCEPTIBILITY PROFILES OF CLOSTRIDIUM DIFFICILE ISOLATES IN
NEW ZEALAND, 2009
N. Al Anbuky;*1 S. Paviour;1 T. Kemp,1 T. Swagger;1 C. Pope;2 H. Heffernan;2 S. A.Roberts1
1
Anaerobe Section, Department of Microbiology, LabPlus, Auckland, New Zealand 2Nosocomial Infections
Laboratory, ESR, Wellington, New Zealand
Little is known about the Clostridium difficile strains that are currently circulating in New Zealand or
whether the epidemic hypervirulent strain, PCR ribotype 027 is present in New Zealand.
Eight laboratories, from throughout New Zealand, participated in the survey. Faecal specimens that were
C. difficile toxin positive were submitted for culture. Specimens were cultured on to CCF agar and isolates
were identified by their colonial appearance and typical biochemical profile. Susceptibility testing was
carried out using the agar dilution MIC method and where appropriate CLSI interpretative criteria were
applied. The antimicrobial agents tested were penicillin, piperacillin-tazobactam, vancomycin,
ciprofloxacin, moxifloxacin, clindamycin, clarithromycin, meropenem and metronidazole. Isolates were
PCR ribotyped according to the method used by the National Public Health Service for Wales. The
ribotyping profiles were compared against reference strains.
Between 1st February and 2nd June 2009, 159 toxin-positive faecal specimens were cultured. C. difficile
was isolated from 103 specimens collected from 97 patients. There were 41 distinct ribotyping profiles
among the 103 isolates. Antimicrobial susceptibility testing showed that most isolates were fully
31
susceptible to the range of antimicrobial agents tested. Isolated resistance to macrolides, clindamycin and
fluoroquinolones was seen.
There is a wide range of C. difficile ribotypes circulating in New Zealand. The hypervirulent strains PCR
ribotype 027 is not present in New Zealand and antimicrobial resistance currently is uncommon.
50. PHARMACOKINETIC STUDY OF INTRAVENOUS LEVETIRACETAM IN TERM NEONATES WITH SEIZURES
C. Sharpe1, E. E. Capparelli2, A. Mower3, M. J. Farrell2 , R. H. Haas2,,3
1
Department of Neuroservices, Starship Children’s Hospital, Auckland, New Zealand; 2Department of
Pediatrics, University of California, San Diego, La Jolla, CA. 3Department of Neurosciences, University of
California San Diego Medical Center, San Diego, CA
Objectives: To determine levetiracetam pharmacokinetics in neonates with seizures and obtain
preliminary safety and efficacy data.
Methods: Eighteen term neonates with neonatal seizures that persisted after 20mg/kg of Phenobarbital
received intravenous treatment with levetiracetam for one week. Peak and trough serum levels were
measured and urine collections were performed to allow calculations of pharmacokinetic parameters: Vd,
CL day 1 and day 7, T1/2 day 1 and day 7. In addition to clinical observation for adverse events, laboratory
safety measurements were performed at baseline, after 48 hours and after 7 days. EEG monitoring of
subjects allowed preliminary assessment of the efficacy of levetiracetam in neonates with seizures
refractory to Phenobarbital.
Results: Mean volume of distribution was 1.01 L/kg, (standard deviation 0.13 L/kg). Mean clearance was
0.043 L/h/kg, (standard deviation. 0.016 L,/h/kg) on day 1 of the study, but increased to 0.079 L/h/kg,
(standard deviation 0.021 L/h/kg) by day 7. Mean half life was 18.5 h, (standard deviation 7.1h) on day 1
of the study, decreasing to 9.2 h, (standard deviation 2.0 h) by day 7.
No study related serious adverse events were observed.
Conclusion: Clearance of levetiracetam in neonates was higher than predicted and increased significantly
during the first two weeks of life. Further safety and efficacy data are needed to develop the potential of
levetiracetam as a treatment in this population.
51. COORDINATION OF THE HITBIC TRIAL QUALITY SCREENING VS QUIETLY SCREAMING. IT’S ALL SO
EASY IN RETROSPECT!
C. Sherring, Research Co-ordinator, Paediatric Intensive Care Unit,
Starship Children’s Hospital, Auckland
The HiTBIC trial is a randomised controlled pilot study of 55 children admitted with a severe traumatic
brain injury (TBI) to a Paediatric Intensive Care Unit in Australasia. The children were randomised to either
Normothermia or Hypothermia and temperature maintained for 72 hours. The study was undertaken to
ascertain feasibility for a larger international study of Hypothermia in TBI. Starship Hospital in Auckland,
New Zealand has been the coordinating centre for the study which has taken place across 1 unit in New
Zealand, 7 units in Australia and 1 in British Colombia, Canada. Recruitment started in November 2006
and was complete by May 2010 when the target of 55 children was reached. In the 42 months that the
pilot study has run 760 children have been screened for eligibility. All 55 CRF’s for randomised children
have been received by the coordinating site, checked for missing data, and verified complete.
There are many valuable lessons that are learnt along the way when co-ordinating a multi-centre study,
many that are associated with trials and tribulations that unexpectedly occur. These insights form the
basis of recommendations for future multi-centre international collaborations that may help deliver a
smooth, efficient and timely coordination process by the research nurse without too many unanticipated
surprises.
32
52. PDA- IT’S THE ONLY WAY
C. Sieczkowski
Infection Prevention & Control Service, ADHB.
Context: All 21 DHB’s in NZ committed to a National Quality Improvement Programme (NQIP) with
implementation of a national hand hygiene campaign, consistent with the WHO Guidelines. The campaign
involves increased use of an alcohol-based hand product and a multi-modal culture change approach to
improve healthcare worker compliance with good hand hygiene practice.
Improvement Issue: Nationally consistent hand hygiene compliance auditing and the use of a smart,
technology based solution to minimise compliance data collection, analysis and reporting workloads.
Process: Manual, paper-based compliance auditing followed by data entry in other countries undertaking
similar projects is labour intensive and introduces the risk of transcription errors.
Strategy: A national training and validation programme for DHB teams of ‘Gold Auditors’ led by five
national ‘Platinum Auditors’ with formal assessments of auditing competence and consistency with a preset pass mark. The development of a data management solution involving the use of hand –held PDA’s to
collect and download audit data to a central database and the ability to generate reports for both DHB
and national purposes.
Evidence: All DHB’s have auditors whose competence has been validated through the national training
and validation process. The data management solution is being used throughout NZ.
Future Steps: Maintaining a national co-ordination function to continue delivery of the standardised
training programme and national data collection, analysis and reporting facility.
53. ANTIMICROBIAL CONSUMPTION AT AUCKLAND CITY HOSPITAL 2006-2009
R. Ticehurst1, M. Thomas2
1
Medicines Information Manager, Pharmacy Department, Auckland City Hospital; 2Infectious Diseases
Physician, Auckland City Hospital.
Aim: We aimed to determine the level of antimicrobial consumption by adult inpatients at Auckland City
Hospital (ACH) and to compare this with other developed nations.
Methods: The computerised records of the ACH pharmacy determined the number of defined daily doses
(DDDs) dispensed to inpatients between 2006 and 2009. Data on the number of admissions and inpatient
days, and information from the 2006 census, were used to calculate antimicrobial consumption for adult
inpatients measured in DDDs/100 admissions, DDDs/100 inpatient days and DDDs/1000 population.
Results: Total antimicrobial consumption by adult inpatients increased from 2006 to 2009. Consumption
levels did not vary greatly with season. Total level of consumption was very similar to that seen in adult
inpatients in Australia and Scandinavian countries. The level of consumption of fluoroquinolones, third or
fourth generation cephalosporins, carbapenems and vancomycin (antimicrobial classes that are restricted
at ACH) was comparable to or less than that seen in adult inpatients in hospitals in Australia or
Scandinavian countries. However, the use of beta-lactamase inhibitor combinations was greater than that
of Scandinavian hospitals.
Conclusion: The antimicrobial stewardship programme at Auckland City Hospital has resulted in a
generally prudent level of consumption in recent years. Opportunities exist to improve the pattern of
antimicrobial prescribing in the expectation that this will help to slow the spread of antimicrobial
resistance in our community.
33
54. AUDIT OF DISCHARGE PRESCRIPTIONS ON OLDER PEOPLE’S HEALTH (OPH) WARDS AT AUCKLAND
DISTRICT HEALTH BOARD (ADHB)
P Vareed, B. Rehman, P. Gelber
Auckland District Health Board (ADHB)
Introduction: Unintentional medication discrepancies are common at interfaces of care and can lead to
medication errors and adverse drug effects. Elderly patients have a higher risk of medication errors.
Aim: To identify and grade medication errors due to transcription on discharge in from 4 Older People’s
Health wards at ADHB.
Methods: Prospective audit (March – April1 2009): Discharge prescriptions were reconciled against
current inpatient medication charts. Any discrepancies identified were clarified with the prescriber,
confirmed as medication error, amended prior to discharge, and graded independently for clinical
significance by four clinical pharmacists.
Retrospective audit: medications on the correct/corrected discharge prescription were compared to
medications on the discharge summary. Any difference was recorded as a medication discrepancy
Results: Prospective audit: 34% of discharge prescriptions (38/112 prescriptions) contained at least one
potential medication error; however error rate per medication prescribed was only 4% (49 errors/1227
medications). The most common error (12/44) was incorrect frequency of medication. The majority of
medications errors (80%) were graded as having minimal consequences. Retrospective audit: medications
on 51% of corrected discharge prescriptions (55/108) did not match medications on the electronic
discharge summary.
Discussion: Medication errors due to transcription on discharge, and discrepancies between the discharge
prescription given to the patient and the discharge summary saved on the hospital electronic system
leads to incorrect medicine information passed onto primary care.
55. PARENTAL KNOWLEDGE OF AND ATTITUDES TOWARD THE HUMAN PAPILLOMAVIRUS VACCINE
B. Venning; An abstract of a dissertation submitted in partial fulfillment of the requirements for the
degree of a Bachelor of Nursing (Honours) at the University of Auckland.
Human Papillomavirus (HPV) is the most common sexually transmitted infection worldwide. Two types of
the virus are principal risk factors for cervical cancer and are responsible for thousands of female cancer
deaths annually around the globe. A vaccine to protect against HPV has recently been developed and is
now available in New Zealand. Despite its advantages, the vaccine has proved to be controversial and has
received varying parental acceptance. The aim of this study was to ascertain an insight into parental
knowledge of and attitudes toward the vaccine; and the overall uptake of the vaccine. A sample of
parents with daughters eligible for the vaccine was recruited to complete a voluntary questionnaire
devised to assess these factors. The study found that while parents had a high awareness and knowledge
of the virus and the vaccine, their uptake of the vaccine was poor. Concerns regarding the lack of
information provided about the vaccine and the vaccines safety were the main reasons parents chose not
to immunise. Although unable to be generalised to the nation at large due to a small sample, the results
provide useful insights about parents and the HPV vaccine during the first two years of the vaccines
availability in New Zealand.
34
56. RATES OF DRUG RESISTANT MYCOBACTERIUM TUBERCULOSIS AMONGST HIV-POSITIVE PATIENTS,
PHNOM PENH, CAMBODIA
G. Walls1, L. Molfino2, S. Bulifon3, N Hurtado4, T. Daneth5
1
Infectious Diseases Registrar, Auckland City Hospital; 2Medical Coordinator, Médecins Sans Frontières,
Cambodia ; 3Medical Doctor, Médecins Sans Frontières, Cambodia ; 4TB Reference Desk Coordinator,
Médecins Sans Frontières, Paris; 5Tuberculosis Nurse, Médecins Sans Frontières, Cambodia
Background: Médecins Sans Frontières (MSF) supports a cohort of HIV-infected patients in Phnom Penh
and in 2007 instituted a programme for identifying and treating patients co-infected with DR-TB and HIV.
Aim: To ascertain rates of drug resistance amongst Mycobacterium tuberculosis isolates from HIV/TB coinfected patients in a large Cambodian cohort.
Methods: All specimens from patients suspected of having tuberculosis between December 2007 and
December 2009 were sent to a reference laboratory for culture. All Mycobacterium tuberculosis isolates
were tested for susceptibility to first-line anti-tuberculosis drugs. Data were collected by reviewing
patient files and culture results, and included gender, site of infection, specimen type, tuberculosis case
definition, sputum smear status and drug susceptibility.
Results: 290 Mycobacterium tuberculosis isolates from 251 patients were sent for drug susceptibility
testing. 22 patients (8.8%) had multi-drug resistant (MDR-) TB; 8 (3.6%) were recorded as new cases, and
12 (54.5%) were sputum smear-positive. A further 64 patients (25.5%) had infection with drug-resistant
tuberculosis other than MDR-TB. Isoniazid resistance occurred in 30 patients (12%), 27 of which were
new cases.
Conclusion: These data suggest a high rate of DR-TB amongst HIV-infected Cambodians, with some
transmission of MDR-TB to new cases. These findings have implications for Cambodia’s national TB
programme and provide a strong argument for investing in drug susceptibility testing in Cambodian
laboratories.
57. DOES THE READY-FOR-WORK PROGRAMME IMPROVE INTERNATIONAL MEDICAL GRADUATE (IMG)
RETENTION?
D. Wan, G. Naden, A. Nahill
Introduction: NZ faces a shortage of doctors, and a large portion of the medical workforce are
international medical graduates (IMGs). Despite job availability and doctor shortages, the retention rate
for IMGs is 50% one-year post-registration.
The “Ready for Work” (RFW) training programme at Auckland City Hospital is designed to help support
IMGs over 26-weeks as they make the transition to working in a NZ hospital. Programme includes
orientation, regular tutorials, being attached to a House Officer on the ward, and regular assessments.
Evaluating whether this programme helps improve integration and retention can give insight into a
valuable group of doctors.
Aim: To investigate whether the RFW programme improves retention of the IMGs in NZ. This study also
seeks to find out whether IMGs perceive there to be greater difficulty getting placement onto vocational
training programmes as compared to NZ graduates, and the reasons they leave NZ.
Methods: IMGs who participated in the RFW programme and IMGs who did not partake in the RFW
programme but were employed in the Auckland region & Waikato Hospital between 2006 and 2010 were
surveyed. The online survey had questions relating to the perceived usefulness of the RFW programme
and factors influencing IMG retention.
35
Conclusion: The results of this study will allow us to better understand the extent to which the objectives
of the RFW programme are being met.
58. LEFT VENTRICULAR ASSIST DEVICES – THE NEW ZEALAND EXPERIENCE
J. White, P. Ruygrok, H. Gibbs, K. Finucane, P. Alison, C. Wasywich, P. Nand, M. Edwards, A. McGeorge, A.
Coverdale
New Zealand Heart and Lung Transplant Service, Auckland City Hospital.
Introduction: The scarcity of donor organs and New Zealand’s geographic isolation has supported the
introduction of left ventricular assist devices (LVAD) to “bridge” eligible patients to cardiac
transplantation.
Methods: The records of all NZ patients who received LVAD were reviewed and data collected. Their
clinical details and outcomes are reported.
Results: Between June 2005 and October 2010, 9 patients (8 male; median age 39, range 10-61) were
supported for 1102 patient-days (median 60, range 11-372 days). Six cases were due to dilated
cardiomyopathy. Seven patients were in class IV heart failure with 3 on Extracorporeal Membrane
Oxygenation and 8 on inotropic support prior to implantation. Devices used included VentrAssist (6),
Heartware (2) and Berlin Heart paracorporeal pump (1) LVAD. The median time in intensive care following
implantation was 11 days. Complications included stroke (2), wound or device infection (3), systemic
sepsis (4), bleeding (5) and right ventricular failure (3). Four patients were transplanted, all of whom
remain well. Two cases are ongoing. Survival at 1 month and 1 year of follow-up was 87% (7/8) and 67%
(4/6) respectively.
Conclusion: Mechanical (LVAD) support of transplant eligible heart failure patients is an important adjunct
to a cardiac transplantation programme.
59. SIMULTANEOUS MEASUREMENT OF RETINOL, TOCOPHEROL AND B-CAROTENE IN SERUM BY
REVERSED PHASE HPLC: CONSIDERATION OF CHROMATOGRAPHIC CONDITIONS
G. Woollard, A. Hammer-Plecas
Department of Chemical Pathology, LabPlus, Auckland City Hospital, Auckland, New Zealand
60. ENOXAPARIN USAGE FOR VENOUS THROMBOEMBOLISM PREVENTION IN SURGICAL WARDS AT
AUCKLAND DISTRICT HEALTH BOARD (ADHB)
C E Young, A. Harrex
Auckland City Hospital, Auckland
Introduction: Venous thromboembolism (VTE) is a major yet preventable problem for surgical patients.
Deep vein thrombosis (DVT) can occur in >50% of some groups of hospitalised patients 1. DVT diagnosis
and treatment increases the cost and duration of hospital stays, is unpleasant for patients and can lead on
to pulmonary embolism (PE), the commonest cause of preventable death in this patient population.
Aim: To establish if ADHB surgical wards are appropriately prescribing VTE prophylaxis for all patients, as
per Best Practice Guidelines for Australia and NZ.
Methods: One-day prospective snap-shot audit of ADHB surgical wards in May 2009. For all patients ward
pharmacists established what VTE prophylaxis was currently prescribed (chemical and mechanical) and
compared with the guideline.
Results: Of 131 patients, 101 (77%) had some form of VTE prophylaxis but only 46 (35%) were prescribed
both chemical and mechanical VTE prophylaxis correctly. Most (65%) were not prescribed prophylaxis
36
according to guidelines and 23% were not prescribed any form of prophylaxis. Patients in the high-risk
group were the least likely to have correct prophylaxis (21%).
Both chemical and mechanical VTE prophylaxis
Correct
Incorrect
High risk
n=47
10 (21%)
37 (79%)
Medium risk
n= 42
14 (33%)
28 (67%)
Low
risk
n=42
22 (52%)
20 (48%)
Discussion: Strategies for improved prescribing of VTE prophylaxis are required.
61. AN AUDIT OF CARDIOVASCULAR RISK FACTOR MONITORING IN ACUTE ADULT INPATIENT MENTAL
HEALTH WARDS AT AUCKLAND DHB
CL Young, G. Boo
Background/Introduction: Severe mental illness has been associated with reduced life expectancy and
poor physical health; of which cardiovascular disease is a significant cause of morbidity and mortality.
Evidence suggests that routine monitoring of cardiovascular risk factors does not occur. Without relevant
monitoring of risk factors, individual cardiovascular risk cannot be calculated and managed accordingly.
Aim: To determine whether individual 5-year absolute cardiovascular risk can be calculated from the
cardiovascular risk monitoring that occurs during an admission to the acute adult mental health unit at
Auckland DHB.
Methods/Study Design: A record of cardiovascular risk factors monitored at baseline and during
admission was retrospectively obtained from case notes for 100 randomly selected patients admitted to
the acute adult mental health unit at ADHB from 1 July to 31 December 2008.
Results: Adjusted individual 5-year cardiovascular risk was able to be calculated in 57% of admissions and
in 60% of patients admitted.
Discussion and Conclusion: The main finding of this audit was that only 60% of patients in this sample had
sufficient monitoring to enable calculation of adjusted individual 5-year absolute cardiovascular risk. It is
not known if this has led to worse outcomes for those not monitored adequately.
62. DEVELOPING A WHOLE-SYSTEM PERSPECTIVE OF PATIENT FLOW
A. Peterson
As the challenges faced by modern hospitals continue to gain public and government attention, there are
increasing calls from within the health sector to take a "whole-system" approach to hospital improvement
efforts. However, there is little, if any, helpful commentary on how a whole-system approach can be
achieved when the principal barrier is the sheer complexity of large modern hospitals. This study is an
illustrative investigation of how new methods at the interface of computational statistics and data mining
may provide a robust, quantitative approach to gaining a whole-system perspective of a large modern
hospital. The outcome was the creation of process maps showing the pathways of all acute patients who
entered Auckland City Hospital during the fiscal year 2009-2010. These maps can easily be abstracted to
different levels of detail to help comprehend the complexity of patient pathways. In addition, the maps
can be analysed to identify principal bottlenecks to process flow and converted into parameterised
simulation models for testing process changes before implementation. The methods illustrated here can
be used in any scenario where events and their timing are recorded electronically. Examples include
patient pathways through wards, clinical specialties, and clinical treatment pathways.
37
63. REDUCING OCCUPANCY AND EMERGENCY DEPARTMENT WAIT TIMES FOR GENERAL MEDICINE
PATIENTS BY INCREASING LEVELS OF WEEKEND SERVICE – A SIMULATION STUDY
A. Peterson
There is increasing evidence from hospitals around the world that reduced levels of service during
weekends have a negative effect on patient care, hospital occupancy, and patient flow. A computer
simulation was performed to estimate the effect that full 7-day service may have on General Medicine
discharge rates and inpatient occupancy over a 12 month period. The results suggest that up to 8400 bed
days/year may have been freed up (approximately 23 fewer patients in beds each day) for General
Medicine over this period, with an average daily reduction of 2.7 hours in the mean time that General
Medicine patients in the Emergency Department wait for an inpatient bed.
38