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Aim: To estimate rates of presenteeism in the New Zealand senior medical workforce and identify reasons why this workforce feels pressured to work through illness., Methods: A cross-sectional survey was returned by 1,806/3,740 publically employed senior doctors and dentists (48%). Relationships between rates of presenteeism, sick leave and demographic factors were explored alongside views on cultural and professional norms., Results: Presenteeism was reported by 88% of respondents. Women and younger doctors had highest rates of presenteeism. Reasons for presenteeism included difficulties accessing short-term sickness cover and concern for the impact of sick leave on patients as well as sociocultural norms., Conclusions: Presenteeism is a widespread behavioural norm in this medical workforce. Choosing whether to work through illness reflects the high value placed on duty of care, but also tensions around defining responsible behaviour in this regard.

Aims: Patients with chest pain of uncertain origin are often referred to gastroenterology to assess for possible oesophageal causes. Oesophageal spasm is difficult to ascertain with stationary manometry, as pain seldom occurs during this brief study. Twenty-four-hour ambulatory manometry and oesophageal pH recording (AMP) offers the opportunity to correlate pain symptoms with abnormal motility or acid reflux for more definitive diagnosis. AMP has been available at Christchurch Hospital since 2000 and we describe our experience., Methods: Thirty-seven patients (23 female, 14 male) underwent AMP between January 2000 and January 2004. Tracings were analysed by automated software and manually by an experienced scientist and gastroenterologist. Case-notes were reviewed for history and drug data., Results: Thirty-three patients (89%) experienced typical pain and/or dysphagia symptoms during AMP. Twenty-one had no correlation between symptoms and pH or manometric abnormalities, excluding reflux disease or an oesophageal hypercontractile disorder as a cause of symptoms. Only one patient had oesophageal spasm proven. One patient's pain correlated strongly with acid reflux. Seven others had reflux episodes during AMP with less consistent pain correlation. At least six patients required treatment for ischaemic heart disease after a negative AMP result., Conclusions: AMP has been a useful additional investigation for chest pain and was able to exclude oesophageal causes of pain in most patients studied. Oesophageal spasm appears to be a rare cause of chest pain in Christchurch. When a diagnosis was made on AMP, it was most often gastro-oesophageal reflux disease.

Aim: To establish an assay service for thiopurine methyl transferase (TPMT) activity in order to facilitate dose initiation of thiopurine drug therapy and to define appropriate reference intervals and optimal cut-offs for the New Zealand population., Methods: 407 patients underwent radio-enzymatic assay testing of TPMT activity prior to initiation of thiopurine drug therapy. Those with low activity also underwent genotyping for the abnormal *2, *3A, and *3C alleles., Results: A trimodal distribution of enzyme activity was seen consistent with the known polymorphic genetics for this enzyme. Three cases of homozygous deficiency were identified. The 'normal' range is 9.3 to 17.6 units/ml red blood cells (RBCs), but many heterozygotes have activity above the lower limit of his range. TPMT activity above 10.7 units/ml RBC identifies a normal genotype with 100% probability., Conclusion: The normal range for TPMT has been established. The measurement of TPMT activity helps to guide dose initiation and may prevent toxicity from azathioprine.

Aim: The measurement and assessment of digoxin concentrations are often performed poorly. We have conducted an audit to assess the appropriateness of digoxin therapeutic drug monitoring in Christchurch Hospital., Methods: One hundred consecutive requests for digoxin concentrations in Christchurch Hospital inpatients were assessed. The case notes and hospital medication records were reviewed to determine the indication for testing, the appropriateness of the sampling time and of the subsequent alteration to dosing., Results: In 53% of requests no clear indication for digoxin therapeutic drug monitoring (TDM) could be determined. In the remainder, 'suspected toxicity' accounted for 31% and 'therapeutic failure' for 16%. Samples were inappropriately taken within eight hours post-dose in 32% of requests. In 19% of cases, the samples did not reflect steady-state conditions. In 5% of occasions, the subsequent decision regarding dose adjustment was felt to be clearly inappropriate, and there was uncertainty regarding appropriateness in some other cases. Overall, in only 29% of requests was TDM performed appropriately with regard to indication, sampling and subsequent dose alteration., Conclusions: At Christchurch Hospital, the practice of TDM for digoxin is often inappropriate. It would seem that medical staff education is required to improve this practice.

Aim: To determine the prevalence of hepatitis A (HAV), hepatitis B (HBV) and hepatitis C (HCV) in adults randomly selected from the Christchurch community., Methods: A list of names was randomly generated from the Christchurch electoral roll and subjects were sequentially contacted and invited to participate. A blood sample was taken and tested for hepatitis A (IgG anti-HAV antibody), hepatitis B (HBsAg and anti-HBc) and HCV (anti-HCV antibody) using Abbott Elisa kits. Subjects positive for HBsAg were also tested for HBeAg/HBV DNA. Those positive for anti-HBc were tested for anti-HBs. HCV antibody positive samples were tested for HCV RNA using PCR., Results: 1064 subjects (30.3% of those invited) participated in the study. The prevalence of HAV antibodies was 27.9%, and increased with age. The overall prevalence of HBV markers was 42/1064 (4.2%), and of these 0.3% were HBsAg positive and 3.9% were considered immune. No gender or ethnic differences in these proportions were observed. The seroprevalence of HVC antibody was 3/1064 (0.3%), two of whom were also PCR positive for HCV RNA., Conclusion: In the Christchurch community there was a high prevalence of antibodies to HAV, which increased with age. The prevalence of HBsAg and antibody to HCV were both low at 0.3%.