The requirement to respect autonomy - The Royal New Zealand ...

RESEARCH GEMSGems of New ZealandPrimary Health Care ResearchAll you need to know aboutcongestive heart failureThis paper provides an overview of thediagnosis and management of congestiveheart failure (CHF) in primary care.It highlights the distinction betweensystolic (low ejection fraction CHF) anddiastolic (preserved ejection fractionCHF) and valvular causes which requiresan echocardiogram. This is essential asthe management is quite clear for systolicdysfunction requiring maximal ACEinhibitors (e.g. cilazapril 5 mg daily)and maximal beta blockers (metoprolol190 mg daily or carvedilol 25 mg twicedaily). If that does not work then spironolactone25 mg per day and/or digoxin arepossibilities. There is little evidence forthe management of diastolic dysfunction.Arroll B, Doughty R, Andersen V.Investigation and management of congestiveheart failure. BMJ. 2010;341:c3657Corresponding author: Bruce ArrollEmail: b.arroll@auckland.ac.nzTargeting CVD modifiable riskfactors in Pacific people mayredress health inequalitiesPREDICT is a web-based clinical decisionsupport programme for assessingand managing cardiovascular disease(CVD) risk in primary care. Over70 000 risk assessments were undertakenbetween 2002 and 2009. Pacificpatients tended to be risk-assessed fouryears younger than Europeans. Amongthose who were assessed, Pacific menwere 1.5 times as likely to smoke asEuropeans. Pacific patients were alsothree times as likely to have diabetes andhad significantly higher diastolic bloodpressures and higher CVD risk thanEuropeans. Targeting these modifiablerisk factors may help redress some ofthe health disparities between Pacificpeoples and Europeans.Grey C, Wells S, Riddell T, Kerr A, GentlesD, Pylypchuk R, Marshall R, Ameratunga S,Drury P, Elley CR, Kyle C, Exeter D, Jackson R.A comparative analysis of the cardiovasculardisease risk factor profiles of Pacific peoplesand Europeans living in New Zealandassessed in routine primary care: PREDICTCVD-11”. N Z Med J. 2010;123: 62–75.Corresponding author: Corina GreyEmail: c.grey@auckland.ac.nzLearning to fit in on the surgical wardThis is an observational study of 4thyear medical students in their first yearof clinical training who were observeddoing their surgical attachment. Communitiesof clinical practice are groupsof health professionals who cometogether with the specific and commonpurpose of patient care and the studentsjoin these transient communities as participantswho are both peripheral and legitimate.In these groups students learnand internalise the normative professionalvalues and behaviours they witnessand experience within the disciplinaryblock of the medical school and teachinghospital and through their participationlearn how to ‘be one of us’.Jaye C, Egan T, Smith-Han K. Communities ofclinical practice and normalising technologiesof self: learning to fit in on the surgical ward.Anthropology & Medicine. 2010;17(1):59–73.Corresponding author: Chrystal JayeEmail: chrystal.jaye@otago.ac.nzThe impact of point of carelaboratory testingThis study looked at the impact ofintroducing point of care (POC) laboratorytesting into a small rural hospitalin the Far North ( Rawene Hospital).This enabled clinicians to perform asmall range of on-site laboratory tests foracutely unwell patients. Previous turnaroundtime for laboratory results was24–72 hours. Data collected includedtest indication, differential diagnosisand planned patient disposition pre- andpost-POC tests. POC testing significantlyimproved diagnostic certainty,reduced overall hospital admissions by18% and inter-hospital transfers by 62%,resulting in substantial overall savingsto the health service.Blattner K, Nixon G, Dovey S, Jaye C,Wigglesworth J. Changes in clinical practiceand patient disposition following theintroduction of point-of-care testing in arural hospital. Health Policy. 2010;96:7–12.doi;10.1016/j.healthpol.2009.12.002Corresponding author: Katharina BlattnerEmail: katiblattner@hokiangahealth.org.nzGEMS are short précis of original papers published by NZ researchers. For a copy of a full paper pleaseemail the corresponding author. Researchers, to have your work included please send a 100word summary of your paper and the full reference details to: editor@rnzcgp.org.nz350 VOLUME 2 • NUMBER 4 • DECEMBER 2010 J OURNAL OF PRIMARY HEALTH CARE