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Objective: Sodium valproate's teratogenicity has prompted increasing restrictions to its use. Our initial audit 2 years prior demonstrated continuing hazardous prescription to women of childbearing age in a New Zealand psychiatric inpatient unit, consistent with nationwide dispensing data. Method: Following a service-wide educational intervention and application of "black box" warnings, we conducted a follow-up audit of valproate prescription in the same inpatient unit by reviewing records of women admitted over a 10-month period (March 2020–January 2021). Results were compared with local and international guidelines, and against data from our initial audit. Results: Two hundred and sixty-one women of childbearing age were admitted over the sampling period, 26 of whom (10%) were prescribed valproate on discharge. Over three quarters (77%) of these patients had diagnoses other than bipolar affective disorder, valproates only approved psychiatric indication in New Zealand. Following intervention, significant improvements were observed in several key indicators of prescribing quality: pregnancy testing, documentation of contraception status, and discussion of teratogenic risk. Conclusions: Following intervention, re-audit demonstrated reduced prescription of valproate and improved management of its teratogenic risk in women of childbearing age receiving inpatient psychiatric care. These results demonstrate the value of a systematic approach to improve prescribing practice. [ABSTRACT FROM AUTHOR]

Background: Hospitalisation of a child is a unique opportunity for health staff to offer smoking cessation support; that is screening for carer smoking status, discussing cessation and providing interventions to carers who smoke. This has the potential to reduce the child's exposure to second-hand smoke, and in turn tobacco related illnesses in children. However, these interventions are not always offered in paediatric wards. The aim of this study was to explore the provision and prioritisation of smoking cessation support to patient carers in a paediatric ward with a high proportion of Aboriginal patients and carers in a regional area of Australia's Northern Territory. Methods: This is a qualitative descriptive study of data collected through semi-structured interviews with 19 health staff. The interviews were audio recorded and transcribed verbatim. Thematic analysis was performed on the transcripts. Results: We found low prioritisation of addressing carer smoking due to, a lack of systems and procedures to screen for smoking and provide quitting advice and unclear systems for providing more detailed cessation support to carers. Staff were demotivated by the lack of clear referral pathways. There were gaps in skills and knowledge, and health staff expressed a need for training opportunities in smoking cessation. Conclusion: Health staff perceived they would provide more cessation support if there was a systematic approach with evidence-based resources for smoking cessation. These resources would include guidelines and clinical record systems with screening tools, clear action plans and referral pathways to guide clinical practice. Health staff requested support to identify existing training opportunities on smoking cessation. [ABSTRACT FROM AUTHOR]

Background: Pregnancy represents a time of increased morbidity and mortality for women and their infants. Clinical quality registries (CQRs) collect, analyse and report key healthcare quality indicators for patient cohorts to improve patient care. There are limited data regarding existing CQRs in pregnancy. This scoping review aimed to: (1) identify Australian CQRs specific to pregnancy care and describe their general characteristics; and (2) outline their aims and measured outcomes Methods: The scoping review was undertaken according to Joanna Briggs Institute guidelines. CQRs were identified using a systematic approach from publications (Ovid MEDLINE, PubMed, Google Scholar), peer consultation, the Australian register of clinical registries and web searches. Details surrounding general characteristics, aims and outcomes were collated. Results: We identified two primary sources of information about pregnancy care. (1) Six CQRs are specific to pregnancy (Australia and New Zealand twin‐twin transfusion syndrome registry, Australian Pregnancy Register for women with epilepsy and those taking anti‐epileptic drugs, National Register of Antipsychotic Medication in Pregnancy, Australasian Maternity Outcomes Surveillance System, Neonatal Alloimmune Thrombocytopaenia Registry and the Diabetes in Pregnancy clinical register). (2) Fourteen observational cohort studies were facilitated by non‐pregnancy‐specific CQRs where a subsection of patients underwent pregnancy. Conclusions: Australian CQRs currently report varied information regarding some selected conditions during pregnancy and offer therapeutic and epidemiological insight into their care. Further research into their effectiveness is warranted. We note the lack of a CQR spanning the common problems of pregnancy in general, where significant health, service and economic gains are possible. [ABSTRACT FROM AUTHOR]

Public health problems are often complex and 'wicked' in nature. Wicked problems have multi-factorial causation, are dynamic and often understood and acted upon differently by different actors. Multi-sectoral collaboration is increasingly emphasized for tackling wicked problems through developing a strategic multi-sectoral plan and then taking collective action. Critical systems thinking can support the development of a shared perspective of the problem, strengthen participation in collective action and foster reflective practices to continuously improve both problem understanding and action. In this paper, we present a critical collaboration model, drawing together two complementary theoretical frameworks, as well as insights from three case studies from New Zealand, to offer a systematic approach to adopting a critical systems perspective in public health collaboration. The model provides six questions to make explicit individuals' understandings or assumptions about how others perceive an issue, problem or evidence, and the process of identifying answers strengthens the dialogical and reflective aspects of the collaboration. We indicate some potential areas for the application of the model to integrate critical systems thinking in collaborative practices. [ABSTRACT FROM AUTHOR]

Background: Although many people with chronic low back pain (LBP) improve following conservative treatment, one in five will experience worsening symptoms after discharge from treatment and seek health care again. The current LBP clinical care pathway in many health services lacks a well-integrated, systematic approach to support patients to remain physically active and self-manage their symptoms following discharge from treatment. Health coaching can support people to improve physical activity levels and may potentially reduce health care utilisation for LBP. The primary aim of this study is to evaluate the effect of introducing a coordinated support system (linking hospital outpatient physiotherapy services to a public health coaching service) at discharge from LBP treatment, on the future use of hospital, medical, and health services for LBP, compared with usual care provided at discharge.Methods: Three hundred and seventy-four adults with chronic non-specific LBP will be recruited from the outpatient physiotherapy departments of public hospitals in New South Wales, Australia. Participants will be individually randomised to a support system (n = 187) or usual care group (n = 187). All participants will receive usual care provided at discharge from treatment. Participants allocated to the support system will also receive up to 10 telephone-based health coaching sessions, delivered by the Get Healthy Service®, over a 6-month period. Health coaches will monitor and support participants to improve physical activity levels and achieve personal health-related goals. The primary outcome is the total number of encounters with hospital, medical, and health services for LBP, at 12 months from baseline. A within-trial economic evaluation will quantify the incremental costs and benefits of the support system from a health system perspective, to support reimbursement decision making.Discussion: This study will establish the effect of a coordinated support system, introduced at discharge from treatment, on the future use of hospital, medical, and health services for LBP and various health outcomes.Conclusion: Innovative community-driven solutions to support people with chronic LBP after discharge from treatment are urgently needed. Study findings will help inform health care policy and clinical practice in Australia.Trial Registration: Prospectively registered on the Australian New Zealand Clinical Trials Registry ( ACTRN12620000889954 ) on 10/09/2020. [ABSTRACT FROM AUTHOR]

BACKGROUND: The allied heath, scientific and technical (allied health) workforce is the second largest workforce in New Zealand, providing diagnostic, therapeutic and preventative services. Increasingly consumers present with complex conditions requiring multiprofessional integrated services and a legacy of profession-focused leadership development is being challenged. [1] Future health and disability systems require leaders prepared to lead complex services, less focussed on their professional background and more on understanding their interprofessional services. [2, 3] The Allied health workforce is well placed to lead these systems, providing interprofessional experience, a biopsychosocial lens and collaborative models of practice. AIM: To provide an understanding of the literature and research available that addres ses the leadership of healthcare services by allied health clinicians. METHODOLOGY: An initial database review was completed using a systematic approach, across CINAHL complete; EBSCO Business; Medline; and EBSCO Health databases from March 2020 to September 2020. An expanded search used Google Scholar and NZ, UK and Australian based government websites to access institutional documents, such as policies, reviews and reports. RESULTS: The review identified an emerging pool of research on allied health leadership in Australia and the UK but a paucity of literature on allied health leadership in New Zealand. Three themes were identified and explored within the article: health leadership frameworks, current state and barriers and enablers identified. CONCLUSIONS: Literature advocates for a broader scope of clinicians into strategic leadership roles. Despite evidence of strategic allied health roles in New Zealand there remains a dearth of literature on allied health leadership. To foster and sustain the development of allied health leaders in New Zealand it is important to understand the enablers that impact this process. [ABSTRACT FROM AUTHOR]

Objectives: To provide a succinct, clinically useful summary of the management of bipolar disorder, based on the 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (MDcpg2020). Methods: To develop the MDcpg2020, the mood disorders committee conducted an extensive review of the available literature to develop evidence‐based recommendations (EBR) based on National Health and Medical Research Council (NHMRC) guidelines. In the MDcpg2020, these recommendations sit alongside consensus‐based recommendations (CBR) that were derived from extensive deliberations of the mood disorders committee, drawing on their expertise and clinical experience. This guideline summary is an abridged version that focuses on bipolar disorder. In collaboration with international experts in the field, it synthesises the key recommendations made in relation to the diagnosis and management of bipolar disorder. Results: The bipolar disorder summary provides a systematic approach to diagnosis, and a logical clinical framework for management. It addresses the acute phases of bipolar disorder (mania, depression and mixed states) and its longer‐term management (maintenance and prophylaxis). For each phase it begins with Actions, which include important strategies that should be implemented from the outset wherever possible. These include for example, lifestyle changes, psychoeducation and psychological interventions. In each phase, the summary advocates the use of Choice medications for pharmacotherapy, which are then used in combinations along with additional Alternatives to manage acute symptoms or maintain mood stability and provide prophylaxis. The summary also recommends the use of electroconvulsive therapy (ECT) for each of the acute phases but not for maintenance therapy. Finally, it briefly considers bipolar disorder in children and its overlap in adults with borderline personality disorder. Conclusions: The bipolar disorder summary provides up to date guidance regarding the management of bipolar disorder, as set out in the MDcpg2020. The recommendations are informed by evidence and clinical expertise and experience. The summary is intended for use by psychiatrists, psychologists and primary care physicians but will be of interest to anyone involved in the management of patients with bipolar disorder. [ABSTRACT FROM AUTHOR]

The article discusses the challenges and opportunities for plastic waste recycling in the New Zealand construction industry. It highlights the high percentage of plastic waste in landfills, the impact of plastic production on climate change, and the need for a shift towards a circular economy. The text explores both off-site and on-site barriers to plastic waste recycling, emphasizing the importance of regulatory changes, infrastructure investments, and collaborative efforts to improve waste management practices. The article concludes by stressing the industry's increasing awareness and commitment to sustainable practices, especially among younger generations, as a promising sign for the future of plastic waste recycling in New Zealand. [Extracted from the article]

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Construction industry significantly contributes to New Zealand's economic development. However, the delivery of construction projects is usually plagued by cost overruns, which turn potentially successful projects into money-losing ventures, resulting in various other unexpected negative impacts. The objectives of the study were to identify, classify, and assess the impacts of the factors affecting project cost in New Zealand. The proposed research model was examined with structural equation modelling. Recognising the lack of a systematic approach for assessing the influencing factors associated with project cost, this study identified 30 influencing factors from various sources and quantified their relative impacts. The research data were gathered through a questionnaire survey circulated across New Zealand construction industry. A total of 283 responses were received, with a 37% response rate. A model was developed for testing the relationship between project cost and the influential factors. The proposed research model was examined with structural equation modelling (SEM). According to the results of the analysis, market and industry conditions factor has the most significant effect on project cost, while regulatory regime is the second-most significant influencing factor, followed by key stakeholders' perspectives. The findings can improve project cost performance through the identification and evaluation of the cost-influencing factors. The results of such analysis enable industry professionals to better understand cost-related risks in the complex environment. [ABSTRACT FROM AUTHOR]

This paper presents a Business Recovery Assessment Framework (BRAF) to help researchers and practitioners design robust, repeatable, and comparable studies of business recovery in various post‐disruption contexts. Studies assessing business recovery without adequately considering the research aims, recovery definitions, and indicators can produce misleading findings. The BRAF is composed of a series of steps that guide the decisions that researchers need to make to ensure: (i) that recovery is indeed being measured; (ii) that the indicators of recovery that are selected align with the objectives of the study and the definition of recovery; and, where necessary, (iii) that appropriate comparative control variables are in place. The paper draws on a large dataset of business surveys collected following the earthquakes in Canterbury, New Zealand, on 4 September 2010 and 22 February 2011 to demonstrate the varied conclusions that different recovery indicators can produce and to justify the need for a systematic approach to business recovery assessments. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Bacterial sexually transmitted infections (STIs) contribute to a significant burden of ill-health despite being easy to diagnose and treat. STI management guidelines provide clinicians with evidence-based guidance on best-practice case management. AIM: To determine the extent of adherence to STI management guidelines for partner notification, follow up and testing for reinfection following diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae. METHODS: Retrospective review of electronic patient records for individuals diagnosed with chlamydia or gonorrhoea in eight primary care clinics in Wellington, New Zealand. At each clinic, 40 clinical records were reviewed (320 in total). Outcome measures were: overall numbers (%) of cases with documented evidence of reason for testing, sexual history, treatment, advice, partner notification and follow up. Partner notification outcomes were: n (%) with evidence of partner notification discussion and n (%) with partners advised, tested and treated. Proportions retested between 6 weeks and 6 months and n (%) positive on retesting were also determined. RESULTS: Presenting features and treatment were generally well documented. Recent sexual history including number of partners was documented for half of cases reviewed (159/320). Partner notification discussion was documented for 74% (237/320) of cases, but only 24.4% (78/320) had documentation on numbers of partners notified and 17% (54/320) on numbers of partners treated. Testing for reinfection between 6 weeks and 6 months occurred for 24.7% (79/320), of whom 19% (15/79) re-tested positive. CONCLUSIONS: This research suggests there are gaps in important aspects of patient care following bacterial STI diagnosis -- a factor that may be perpetuating our high rates of infection. A more systematic approach will be needed to ensure people diagnosed with an STI receive the full cycle of care in line with best practice guidelines. [ABSTRACT FROM AUTHOR]

Lead (Pb) poisoning is a significant threat to Aotearoa New Zealand's endangered kea (Nestor notabilis), an avian species important to Māori. Historically, exposure was thought to be from lead‐containing building materials; however, recent field observations suggest lead‐based ammunition as an additional source. We used stable lead isotopes to investigate the sources of lead to kea. Comparing 207 Pb/206 Pb ratios in kea blood (n = 91) to both ammunition and building materials, we found approximately one‐third of exposed kea (blood lead > 10 µg/dL) had lead isotope ratios consistent with exposure to lead‐based ammunition. As lead ammunition is still used, including in government‐sponsored culling programs, our data indicate an urgent need to shift toward non‐lead ammunition use to prevent further poisoning and aid conservation efforts. Collaborating with tangata whenua/Māori guardians, we advocate for immediate policy changes to eliminate lead‐based ammunition in kea habitat to safeguard this endangered culturally treasured species from extinction. [ABSTRACT FROM AUTHOR]

Background/Objectives: Evidence-based guidelines and care standards recommend offering oral nutrition supplements to all older adults with hip fracture, not just those already malnourished. This study aimed to identify the proportion of inpatients in a sample of hospitals in two countries that were provided with oral nutritional supplementation (ONS) following a hip fracture and to identify factors associated with ONS provision. Methods: An analysis of prospectively collected data from a bi-national Hip Fracture Registry nutrition sprint and registry audit data limited to older adults (≥65 years) undergoing surgical intervention for a fractured hip from 1 to 31 August 2021. Multivariable logistic regression was used to identify factors associated with providing ONS. Results: Patient-level data was available for 385 older adults (median 85 years; 60.5% female) admitted to twenty-nine hospitals. Less than half (n = 47.3%) of the audited inpatients were provided ONS. After adjusting for covariates, ONS was more likely to be provided to older adults who were identified as malnourished on formal testing (OR 11.92; 95%CI 6.57, 21.69). Other factors associated with prescription of ONS included those who did not have a preoperative medical assessment (OR 2.26; 95%CI 1.19, 4.27) or were cognitively impaired (OR 1.83; 95%CI 1.01, 3.32), severely frail, or terminally ill (OR 3.17; 95%CI 1.10, 9.17). Conclusions: ONS was provided in line with evidence-based recommendations for less than half of the older adults with a hip fracture in 29 hospitals in two countries. A structured approach to implementation may be required to reduce complications and improve outcomes for all older adults after a hip fracture, not just those assessed as cognitively impaired, frail, and/or malnourished. [ABSTRACT FROM AUTHOR]

Globally, Indigenous Peoples experience widespread health inequities. Treaties provide a potential framework to uphold Indigenous rights and progress health equity. Te Tiriti o Waitangi (Māori language version of the Treaty of Waitangi) established the relationship between Māori, the Indigenous people of Aotearoa (New Zealand), and the British Crown. Grounded in Kaupapa Māori theory, this literature review used an Indigeneity-Grounded Analysis (IGA) policy lens to identify four characteristics of Tiriti-centred population health programmes: whanaungatanga (relationships), pro-equity actions, Te Ao Māori (Māori worldviews), and accountability. Although the evidencebase is emergent, a rights-based approach identifies the centrality of Indigenous self-determination, structural and system transformation, and freedom from discrimination. Indigenous knowledge provides the foundation for treaty-centered policy supportive of Indigenous rights and health equity. [ABSTRACT FROM AUTHOR]

Introduction: In New Zealand, 41% of general practitioners (GPs) intend to retire by 2025. Increasing workforce shortages and other stressors are putting doctors at risk of burnout, which in turn can put patients at risk of harm. Offering a range of resources can signal an organisation's commitment to physician wellness while improving patient safety and organisational stability. Aim: To replace the current reactive approach to impaired doctors with a proactive system of monitoring performance with the goal of identifying problems early. METHODS: This paper reports on an initiative of Pegasus Health Charitable to provide pastoral care to GPs in Canterbury experiencing increased stress, burnout or problems leading to impaired performance. RESULTS: The pastoral care programme has been running successfully for 9 years and has helped 32 GPs. Because of the low numbers, the programme needs to be individualised and confidential. CONC LUSION : Recent developments have seen Pegasus Health adopt a systematic approach to monitoring and supporting health practitioners. This includes the monitoring of available data on GPs at risk. Data collection is being used to manage the "psychological health" of doctors, including complaints, prescribing, referral data and attendance at education sessions. [ABSTRACT FROM AUTHOR]

Aim: To synthesise international literature to identify mechanisms that maintain racism in nursing and understand the factors that contribute to designing and implementing anti‐racist praxis to inform nursing in Aotearoa New Zealand. Design: An integrative literature review was undertaken, integrating Indigenous Kaupapa Māori methodologies to ensure a cultural and philosophical lens. Methods: Peer‐reviewed literature published, between January 2011 and July 2023 were sourced. Of 1296 articles, 16 met the inclusion criteria and 4 were identified via citation chaining. In total, 20 articles were included. The Johns Hopkins Research Evidence Tool was applied, findings extracted, and thematic analysis completed utilising Indigenous Kaupapa Māori principles. Data Sources: Databases, including CINAHL, Scopus, PubMed and Aus/NZ Reference Centre, were searched in July 2023. Results: Two key themes were identified: (1) colonial active resistance to change; and (2) transformational, visionary, and proactive nursing. Conclusion: Nurses are well‐positioned to confront the structures that maintain racism in health and education systems but are often actors in maintaining status quo. Anti‐racist praxis can be a mechanism for nurses to reimagine, redefine and transform nursing care, leadership, and nursing education to begin to eradicate racism. Reporting Method: This integrative review adhered to the 2020 Preferred Reporting for Systematic Reviews and Meta‐Analyses (PRISMA) method. Patient or Public Contribution: No patient or public contribution. Implications for the Profession: Racism remains prevalent in nursing and the healthcare system. It is necessary to implement anti‐racist praxis and policies that resist, deconstruct, and dismantle power and racism while validating Indigenous values, beliefs and practices. This is vital to deliver equitable health care. Impact: This integrative review presents lived realities and knowledge of Indigenous and racially minoritised nurses and scholars, alongside nursing allies to inform anti‐racist praxis. This evidence signifies that it is time to walk the walk to challenge the colonising systems and processes that hold racism in place. [ABSTRACT FROM AUTHOR]

Background: This study evaluates primary care practices' engagement with various features of a quality improvement (QI) intervention for patients with coronary heart disease (CHD) in four Australian states. Methods: Twenty-seven practices participated in the QI intervention from November 2019 –November 2020. A combination of surveys, semi-structured interviews and other materials within the QUality improvement in primary care to prevent hospitalisations and improve Effectiveness and efficiency of care for people Living with heart disease (QUEL) study were used in the process evaluation. Data were summarised using descriptive statistical and thematic analyses for 26 practices. Results: Sixty-four practice team members and Primary Health Networks staff provided feedback, and nine of the 63 participants participated in the interviews. Seventy-eight percent (40/54) were either general practitioners or practice managers. Although 69% of the practices self-reported improvement in their management of heart disease, engagement with the intervention varied. Forty-two percent (11/26) of the practices attended five or more learning workshops, 69% (18/26) used Plan-Do-Study-Act cycles, and the median (Interquartile intervals) visits per practice to the online SharePoint site were 170 (146–252) visits. Qualitative data identified learning workshops and monthly feedback reports as the key features of the intervention. Conclusion: Practice engagement in a multi-featured data-driven QI intervention was common, with learning workshops and monthly feedback reports identified as the most useful features. A better understanding of these features will help influence future implementation of similar interventions. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR) number ACTRN12619001790134. [ABSTRACT FROM AUTHOR]

Mining as one of the fundamental elements of the economy has left tens of thousands of mines abandoned. With increased urbanisation and population growth, industrial or residential sites become prone to post-mining geotechnical hazards such as subsidence from abandoned mining sites. Instabilities of abandoned workings may, also, interfere with active mining, imposing risks and considerable delays in the operations. Proper knowledge of these geotechnical hazards and the mechanisms of instabilities are critical for the classification and prioritisation of the sites for rehabilitation or repurposing of abandoned mining sites. The long-term stability analysis of abandoned mine workings is a complex task for engineering geologists and rock engineers. Numerous factors have been identified here as affecting the stability of underground mining excavations including depth, age, shape, and geometry of the mining excavations, underground water, in-situ stress state in the area, geotechnical characteristics, discontinuities, seismic loading and most importantly weathering and deterioration of the rock masses. To provide an efficient approach for assessing the complex phenomena of geotechnical hazards associated with shallow abandoned underground stopes in hard rock environments, with interconnected parameters, this study proposes a systematic approach by adopting and modifying the Rock Engineering System, RES, (Hudson 1992b). An Interaction Matrix is developed, the critical factors and dominant modes of instabilities are identified, and the hazard potentials are determined. An empirical index known as the Abandoned Mine Instability Index, AMII, is proposed to enable a quick and preliminary assessment of geotechnical instability and subsidence hazards in post-mining areas. This systematic approach was tested against one case history involving multiple crown pillar collapses and sinkhole subsidence incidents related to historic underground stope mining followed by a modern adjacent open pit at the Waihi mine in New Zealand. Information from relevant literature was used to assess the post-mining geotechnical hazards. The outcomes of the study indicate that the methodology can be successfully applied to differentiate between stable and unstable areas at the same mine. Future comparisons of mines in different regions are required to fully confirm the calibration of the AMII. • Abandoned mine stability depends on the hydro-geomechanical characteristics of rocks, and the depth and configuration of workings. • The weatherability of rocks is a key parameter in the long-term stability of abandoned mining excavations. • The Rock Engineering System, RES, can simplify and incorporate the effect of several coupled factors in the stability analysis of old excavations. • The Abandoned Mine Instability Index, AMII, is a useful tool for the rapid and relative assessment of old excavations to prioritise risks across regions. [ABSTRACT FROM AUTHOR]

This study investigated the response to class-wide phonological awareness and oral language teaching for 40 children who entered school with speech and language difficulties. A stepped wedge research design was adopted to compare the immediate impact of the 10-week teacher-led instruction. The progress of the children with speech and language difficulties was monitored over the first school year and compared with 110 children with language difficulties alone and 95 children with typical development. Children with speech and language needs showed a strong intervention response in phoneme awareness and vocabulary learning but needed more support to transfer skills to word decoding and spelling. Implementing the approach earlier in the school year resulted in stronger literacy performance at the year-end for all three groups. The importance of positive speech–language pathologist and teacher collaborations to support a systematic approach to evidence-based foundational literacy teaching is discussed. [ABSTRACT FROM AUTHOR]

Case history: Data were collected from 47 outbreaks of dropped hock syndrome (DHS) that were reported by veterinarians in New Zealand to the Ministry for Primary Industries between October 2012 and August 2017. There were 181 affected dairy cows from 44 farms. Of those with records, all 86 were aged between 2–3 years-old, and 4/94 (4%) were Friesian, 56/94 (60%) were Jersey and 33/94 (35%) were Jersey/Friesian cross. Of the 47 outbreaks, 45 (96%) occurred during winter and 37 (79%) in the South Island. Clinical findings: Of 151 cases with records, hindlimb weakness (117 cows), shortened gait (112 cows) and dropped hocks (106 cows) were most commonly reported, with 110 cases being bilaterally affected. The level of diagnostic work-up and the data recorded by veterinarians for each outbreak were highly variable. Creatine kinase and aspartate aminotransferase activities were reported for 22 cases and were within normal ranges for cows with mild disease but increased in cows with severe disease. Concentrations of Cu in serum and liver were below normal for 13/22 and 9/10 cows, respectively, from six outbreaks. Of 41 cows with records for clinical outcomes, 12 had complete resolution, 18 had partial resolution, and 11 had no resolution. Pathological findings: Post-mortem data were available from 26 cases. Muscle necrosis and haemorrhage of the origin of the gastrocnemius muscle were the key gross findings. In 14 cows with records for muscle histopathology, myodegeneration and recent haemorrhage were observed, and connective tissue pathology was reported to predate muscular pathology in seven cases. Diagnosis: DHS appeared to be a degenerative rather than inflammatory condition primarily affecting the connective tissue of the hind limb, especially at the dense collagen interfaces of the gastrocnemius. Although no evidence of neuropathy was found, this cannot definitively be ruled out as a potential cause. Clinical relevance: A more standardised and systematic approach to investigating cases and recording case data is required to make robust inferences about the aetiology, risk factors, and treatment interventions for DHS. [ABSTRACT FROM AUTHOR]

As smartphone ownership and use by children and youth has increased over the past decade, so has the presence of phones within the classroom. This has created unique challenges for teachers, school leaders, and policymakers. In this research study, we used a cross-sectional survey design to examine educator (n = 217) and student (n = 332) perspectives on students' mobile phone use in New Zealand schools through a mixed-methods approach. The results indicate that both educators and students were in favour of regulating students' phone use at the school level, but they were less in favour of a total ban approach. Most participants thought that students should not be allowed to have phones during class time, with rationale that centred around student learning and safety. Mobile phones were viewed as a distraction to student learning and compromised student safety through inappropriate use (e.g., photos and videos being taken at school and shared), cyberbullying, and social media-related issues. The findings of our research provide insights that are relevant to the development of educational policies around students' mobile phone use at school and contribute to a broader understanding of the impacts of mobile phone use at school on child and youth achievement and well-being. [ABSTRACT FROM AUTHOR]

The rich history of migration of people to New Zealand paved the way for the multicultural environment that it has today. As individuals from different countries with various cultures move to a new environment, they encounter transformations that commence contact and communication with members of the new environment. The constant interaction of both New Zealanders and migrants creates changes in feelings, perceptions, and lifestyles that can be analyzed along with the development of cultural adaptation theories. Social science researchers explained how individuals manage changes within themselves and in the environment and proposed working concepts on adaptation. This paper provides a literature review on the cultural adaptation experiences in New Zealand acculturation, cultural adaptation, and cultural fusion using Berry (1970, 2003, 2005, 2006), Aycan and Berry (1996), and Sam and Berry (2010) on acculturation, Kim (2001, 2017) on cross-cultural cultural adaptation, Kraidy (2005) on cultural hybridity, and Croucher and Kramer (2017) on cultural fusion theory. Discussions are centered on the interplay of concepts and empirical studies in understanding different perspectives on the process of adaptation in New Zealand through a communication lens. [ABSTRACT FROM AUTHOR]

Background: Knee joint mechanics during sidestepping are associated with anterior cruciate ligament injury. Unplanned sidestepping more closely emulates game scenarios when compared with planned sidestepping by limiting decision time, increasing knee loading and challenging the integrity of soft-tissue structures in the knee. It is important to quantify the loads that may challenge the integrity of the knee during planned and unplanned sidestepping. Objective: Our objective was to review literature on knee mechanics during planned and unplanned phases of sidestepping. Data sources: PubMed, CINAHL, MEDLINE (EBSCO), SPORTDiscus and Web of Science were searched using the terms knee mechanics OR knee kine*, AND plan*, unplan*, anticipat*, unanticipat*, side*, cut* or chang*. Study selection: A systematic approach was used to evaluate 4,629 records. Records were excluded when not available in English, only available in abstract of conference proceedings, not involving a change-of-direction sidestep, not comparing planned and unplanned or maintaining a running velocity greater than 2 m s. Data extraction: Included studies were evaluated independently by two authors using a custom-designed methodological quality assessment derived from the Physiotherapy Evidence Database (PEDro) scale and then confirmed by a third author. Data synthesis: Only six studies met the inclusion criteria and were retained for meta-analysis. Magnitude-based inferences were used to assess the standardised effect of the differences between planned and unplanned sidestepping. Knee angles and knee moments were extracted and reported for flexion/extension, abduction/adduction and internal/external rotation for initial contact, weight acceptance, peak push-off and final push-off phases of sidestepping. Results: For kinematic variables, unplanned sidestepping produced a wide range of small to large increases in knee extension angles, small and moderate increases in knee abduction angles and a small increase in internal rotation angle relative to planned sidestepping during the sidestepping manoeuvre. For kinetic variables, unplanned sidestepping produced mostly small (small to large) increases in knee flexor moments, small to moderate increases in knee abductor moments and mostly moderate (small to large) increases in internal rotator moments relative to planned sidestepping. Limitations: Approach velocity constraints during the sidestepping manoeuvre were lifted due to the low number of eligible studies. The varying approach velocities included (ranging from 3.0 to 5.5 m s) may impact the kinematic and kinetic variables examined in this review. Conclusions: Differences in knee mechanics between planned and unplanned sidestepping exist. The most substantial effects occurred during the weight acceptance phase of sidestepping. It seems that biomechanical factors commonly associated with anterior cruciate ligament injury risk are affected the most during the loading phase compared with peak push-off; made evident in the coronal (abductor) and transverse (internal rotator) knee kinetic data presented in this review. The authors of this review propose a rationale for the incorporation of unplanned sport tasks in the development of anterior cruciate ligament injury screening and in prophylactic training programmes. [ABSTRACT FROM AUTHOR]

Optimal nutrition care is important in the management of cystic fibrosis (CF). This paper summarises the '2017 Nutrition Guidelines for Cystic Fibrosis in Australia and New Zealand (NZ)'. CF dietitians formulated 68 practice questions which were used to guide a systematic literature search and review of the evidence for nutrition in CF. Identified papers underwent quality and evidence assessment using the American Dietetic Association quality criteria checklist and the National Health and Medical Research Council of Australia (NHMRC) rankings. Evidence statements, graded recommendations and practice points were developed covering core nutrition topics (assessment and nutrition interventions including oral, enteral and micronutrient supplementation); nutrition-related co-morbidities (including pancreatic insufficiency, CF-related diabetes, bone health and distal intestinal obstruction syndrome); and key new topic areas (genetic modulator therapies, overweight/obesity and complementary therapies). This paper showcases highlights from the guidelines, focussing on new topic areas and geographic and climate considerations for vitamin D, salt and hydration. • This paper summarises the 2017 Nutrition guidelines for CF for Australia and NZ • A systematic approach to evidence appraisal and guideline development was used • Nutrition assessment, nutrition support and micronutrient supplementation are covered • Nutrition-related topics including CF-related co-morbidities and PERT are covered • Novel topic areas include genetic modulators, overweight/obesity and probiotics [ABSTRACT FROM AUTHOR]

Background: It is critical that Indigenous health curricula are designed to effectively prepare graduates to contribute to reducing and eliminating inequities in health. Many of the required competencies are generic across health professions. Te Ara, an overarching graduate profile in Măori health, signals a shared approach to curriculum development across the four major undergraduate health programs at the University of Auckland, New Zealand. This article explains the rationale for Te Ara, describes its development and progress toward implementation, and foreshadows some of the challenges ahead. Developing and implementing the graduate profile: Drawing on the principles of outcome-based education and working collaboratively, the Faculty of Medical and Health Sciences at the University of Auckland has adopted Te Ara, a graduate profile comprising seven high level learning outcomes in Măori health and an associated curriculum framework. Te Ara is now being used to map existing curricula as the basis for a more systematic approach to Măori health teaching, learning and assessment. Discussion and conclusions: Expected benefits of this approach include more transparent, comprehensive, and evidence-based curricula, greater opportunities for interprofessional learning, and potential for sharing of insights and knowledge across programs. However, a number of challenges need to be overcome to create an educational environment in which effective Măori health teaching and learning can occur. Principles and practical insights from our experience are broadly applicable in the area of Indigenous health and cultural competence education internationally. [ABSTRACT FROM AUTHOR]

Adult survivors of child sexual abuse are high users of health and mental health services. Health professionals are well placed to improve health outcomes for them by delivering positive interventions post-abuse. The current study explored female child sexual abuse survivors' opinions on how health professionals could work better with child sexual abuse survivors. Sixty-one women, from 22-65 years old, who had been sexually abused before the age of 16 years, completed postal questionnaires in late 2004. A model was developed to guide the development of knowledge, skills, and practices for working more sensitively with child sexual abuse survivors. The model consisted of six chronological training steps: (1) knowledge on effects of child sexual abuse; (2) establishing the relationship with child sexual abuse survivors; (3) asking about child sexual abuse; (4) responding to disclosure; (5) sensitive provision of medical examinations; and (6) follow-up post examination. A systematic approach to training is proposed to assist with improving delivery of services sensitive to child sexual abuse survivor needs. [ABSTRACT FROM AUTHOR]

This paper proposes a nine‐component analytical framework for developing, comparing, and evaluating road safety strategies. The nine components are: (1) vision; (2) objectives; (3) targets; (4) action plan; (5) evaluation and monitoring; (6) research and development; (7) quantitative modelling; (8) institutional framework; and (9) funding. While the first four components are essential for the formulation of a road safety strategy, the remaining components are key to its successful implementation. To demonstrate the usefulness of this comparative framework, we examine the road safety strategies of six selected administrations: Australia, California, Great Britain, Japan, New Zealand, and Sweden. In these case studies, we extract and highlight good practices in the formulation and implementation of their road safety strategies. The proposed framework also provides a systematic approach for assessing road safety strategies in other administrations. The evaluation of the six case studies forms a benchmarking platform for the planning, formulation, and implementation of good practices for road safety strategies. [ABSTRACT FROM AUTHOR]

Whānau Pakari is a healthy lifestyle assessment and intervention programme for children and adolescents with obesity in Taranaki (Aotearoa/New Zealand), which, in this region, replaced the nationally funded Green Prescription Active Families (GRxAF) programme. We compared national referral rates from the GRxAF programme (age 5–15 years) and the B4 School Check (B4SC, a national preschool health and development assessment) with referral rates in Taranaki from Whānau Pakari. We retrospectively analysed 5 years of clinical data (2010–2015), comparing referral rates before, during, and after the Whānau Pakari clinical trial, which was embedded within the programme. We also surveyed programme referrers and stakeholders about their experiences of Whānau Pakari, analysing their responses using a multiple-methods framework. After the Whānau Pakari trial commenced, Taranaki GRxAF referral rates increased markedly (2.3 pretrial to 7.2 per 1000 person-years), while NZ rates were largely unchanged (1.8–1.9 per 1000 person-years) (p < 0.0001 for differences during the trial). Post-trial, Taranaki GRxAF referral rates remained higher irrespective of ethnicity, being 1.8 to 3.2 times the national rates (p < 0.001). Taranaki B4SC referrals for obesity were nearly complete at 99% in the last trial year and 100% post-trial, compared with national rates threefold lower (31% and 32%, respectively; p < 0.0001), with Taranaki referral rates for extreme obesity sustained at 80% and exceeding national rates for both periods (58% and 62%, respectively; p < 0.01). Notably, a referral was 50% more likely for referrers who attended a Whānau Pakari training half-day (RR = 1.51; p = 0.009). Stakeholders credited the success of Whānau Pakari to its multidisciplinary team, family-centred approach, and home-based assessments. However, they highlighted challenges such as navigating multidisciplinary collaboration, engaging with families with complex needs, and shifting conventional healthcare practices. Given its favourable referral trends and stakeholder endorsement, Whānau Pakari appears to be a viable contemporary model for an accessible and culturally appropriate intervention on a national and potentially international scale. [ABSTRACT FROM AUTHOR]

Background: Health intervention implementation in Aotearoa New Zealand (NZ), as in many countries globally, usually varies by ethnicity. Māori (the Indigenous peoples of Aotearoa) and Pacific peoples are less likely to receive interventions than other ethnic groups, despite experiencing persistent health inequities. This study aimed to develop an equity-focused implementation framework, appropriate for the Aotearoa NZ context, to support the planning and delivery of equitable implementation pathways for health interventions, with the intention of achieving equitable outcomes for Māori, as well as people originating from the Pacific Islands. Methods: A scoping review of the literature to identify existing equity-focused implementation theories, models and frameworks was undertaken. One of these, the Equity-based framework for Implementation Research (EquIR), was selected for adaptation. The adaptation process was undertaken in collaboration with the project's Māori and consumer advisory groups and informed by the expertise of local health equity researchers and stakeholders, as well as the international implementation science literature. Results: The adapted framework's foundation is the principles of Te Tiriti o Waitangi (the written agreement between Māori rangatira (chiefs) and the British Crown), and its focus is whānau (extended family)-centred implementation that meets the health and wellbeing aspirations, priorities and needs of whānau. The implementation pathway comprises four main steps: implementation planning, pathway design, monitoring, and outcomes and evaluation, all with an equity focus. The pathway is underpinned by the core constructs of equitable implementation in Aotearoa NZ: collaborative design, anti-racism, Māori and priority population expertise, cultural safety and values-based. Additionally, the contextual factors impacting implementation, i.e. the social, economic, commercial and political determinants of health, are included. Conclusions: The framework presented in this study is the first equity-focused process-type implementation framework to be adapted for the Aotearoa NZ context. This framework is intended to support and facilitate equity-focused implementation research and health intervention implementation by mainstream health services. [ABSTRACT FROM AUTHOR]

Purpose: This paper examines what facilitates the swift reconfiguration of freight movements across transport modes in the wake of a major disaster. Design/methodology/approach: A qualitative research approach focussing on the New Zealand (NZ) domestic freight transport operations in the wake of the 2016 Kaikōura earthquake is used with data collected through 19 interviews with 27 informants. The interviews are thematically analysed by using the framework method. Findings: The paper provides rich and detailed descriptions of the ability of a freight transport system to recover from a disaster through rapid modal shifts. This paper identifies nine factors enabling modular transport operations and highlights the critical role of physical, digital, operational and inter-organisational interconnectivity in the aftermath of a disaster. Originality/value: Although the management of freight disruptions has become a prevalent topic not only in industry and policy-making circles, but also in the academic literature, qualitative research focussing on the ability of commercial freight systems to adapt and recover from a disaster through rapid modal shifts is limited. This qualitative study sheds light on the mechanisms underlying the continuity of freight operations in the wake of a disaster and provides a comprehensive understanding of modular transport operations and the ability of freight systems to keep goods moving. [ABSTRACT FROM AUTHOR]

Background: While there is increasing evidence on the benefits of PROMs in cancer care, the extent of routine collection and use of PROMs in clinical cancer practice across Australia and New Zealand (ANZ) is unknown. This study examined the prevalence and characteristics of PROMs use in routine clinical cancer care in ANZ. Methods: An online survey was designed and disseminated via professional societies and organisations using a snowball sampling approach to clinical and health administration professionals managing cancer care in ANZ. A poster advertising the study was also circulated on professional social media networks via LinkedIn and Twitter inviting health professionals from ANZ to participate if they were using or intending to use PROMs in clinical cancer practice. Responders opted into the survey via the survey link. Results: From 132 survey views, 91(response rate, 69%) respondents from 56 clinical practices across ANZ agreed to participate in the survey, and of these 55 (n = 55/91, 60%) respondents reported collecting PROMs within their clinical practice. The majority of the respondents were from the State of New South Wales in Australia (n = 21/55, 38%), hospital (n = 35/55, 64%), and a public setting (n = 46/55, 83%). PROMs were collected in all cancer types (n = 21/36, 58%), in all stages of the disease (n = 31/36, 86%), in an adult population (n = 33/36, 92%), applied in English (n = 33/36, 92%), and used to facilitate communication with other reasons (27/36, 75%). A geospatial map analysis provided insights into the variation in PROMs uptake between the two countries and in certain jurisdictions within Australia. This study also highlights the limited resources for PROMs implementation, and a lack of systematic priority driven approach. Conclusion: PROM use across Australia and New Zealand seems variable and occurring predominantly in larger metropolitan centres with limited standardisation of approach and implementation. A greater focus on equitable adoption of PROMs in diverse cancer care settings is urgently needed. [ABSTRACT FROM AUTHOR]

The global impact of the COVID-19 pandemic demanded a swift transition in the usual educational mode of delivery from face to face to online. New Zealand established "a traffic light system" after initial COVID-19 lockdowns, and educational delivery adapted accordingly at a tertiary education provider in Te Pūkenga, Eastern Institute of Technology. This study investigates the ramifications of the traffic light system on this institute's staff, employing semi-structured interviews and an inductive semantic thematic analysis. The findings reveal a universal impact on staff, characterized by an augmented workload attributed to students' absences and illnesses. This led to increased support demands of staff for their students' academic progression. Anxiety, stress, and guilt emerged as prevalent emotions linked to student support. Despite the staff adapting to the mandates, a notable challenge arose from the discord between educational and industry directives, causing confusion among the students. While the study indicates staff resilience in navigating the traffic light changes, it underscores the imperative of recognizing the toll on their wellbeing. The research calls for a proactive consideration of future challenges, emphasizing the importance of safeguarding the mental and emotional health of tertiary education staff amidst potential uncertainties in educational delivery. [ABSTRACT FROM AUTHOR]

This study explains the role of discourse analysis in understanding political speeches by shedding light on the application of theories and techniques of discourse analysis to analyse political discourse. Language is a multi-layered entity, and based on this, the study analyses the meanings and constructs that lie behind the linguistic elements in political speeches. The study is based on three female political speeches viz., those of Jacinda Ardern (the previous New Zealand Prime Minister) in Christchurch's, the first Senate speech of Fatima Payman, a Muslim immigrant to be a senator in the Australian Senate, and the opening speech of Sanna Marin, the Prime Minister of Finland, at NYU in 2023. The selection was made using Fairclough's Framework to identify different topics for speeches. In the analysis, the researcher unravels the underlying meaning in these speeches, and simultaneously the relationships between power and ideology, ideology and identity. Findings showed that the three speeches used many persuasive techniques and rhetorical devices with concealed meanings betraying ideological biases, and persuasive strategies to advance individual agendas. [ABSTRACT FROM AUTHOR]

Habitual dietary intakes and nutrition behaviours developed during childhood and adolescence pave the way for similar behaviours to manifest in adulthood. Childhood obesity rates have now reached a point where one in six children globally are classified as overweight or obese. Schools have the unique ability to reach almost all children during key developmental stages, making them an ideal setting for influencing children's nutrition behaviours. Evidence suggests the school food environment is not always conducive to healthy food choices and may be obesogenic. The aim of this narrative review is to explore factors that influence the healthy food and drink environment in and around schools in New Zealand. The review focused on evidence from New Zealand and Australia given the close resemblance in education systems and school food guidance. Using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework, the school food environment was categorised into the following domains: economic, political, physical and socio-cultural factors. Findings suggest that food policies are not utilised within schools, and guidelines to improve the school food environment are not well implemented. Canteen profit models, lack of staff support and resources, and higher availability of low-cost unhealthy foods are among barriers that hinder implementation. This review highlights recommendations from existing evidence, including canteen pricing strategies, restriction of unhealthy foods and using peer modelling in a time-scarce curriculum to improve the school food environment. Key areas for improvement, opportunities to enhance policy implementation and untapped avenues to improve the food and nutrition behaviours of children are highlighted. [ABSTRACT FROM AUTHOR]

Provincial academies represent an important bridge between amateur and professional level rugby union in New Zealand. Athletes are provided with professional-level coaching; however, limited direct nutrition support is available. Congested training schedules and the requirement to work or study due to a lack of financial support may present a challenge towards athletes meeting nutrition requirements. The aim of the study was to facilitate improvement in nutrient intake, body composition and subjective well-being in provincial academy athletes via the implementation of a nutrition-support protocol based around behaviour change techniques. Significant increases in total energy (pre: 2492 ± 762 kcal; post: 2614 ± 625 kcal), relative energy (pre: 24.4 ± 7.5 kcal·kg; 25.5 ± 6.0 kcal·kg), total protein (pre: 131.1 ± 41.8 g; 153.8 ± 37.1 g) and relative protein (pre: 1.3 ± 0.4 g·kg; post: 1.5 ± 0.3 g·kg) were observed. Furthermore, changes in subjective sleep quality, stress, mood and upper body soreness were observed following the intervention. No changes were observed in body composition, carbohydrate or fat intake. Significant variability in nutrition and body composition changes highlights the importance of applying an individualised approach to nutrition support provision in developmental athletes. Practitioners working within these environments should be aware of the challenges and influences contributing to athletes' nutrition choices and habits. [ABSTRACT FROM AUTHOR]

Competition is a key factor in driving performance improvements across a range of firm activities including reductions in costs, increasing the levels of productivity, promoting entrepreneurial efforts, fostering innovation, driving better management practices, and exercising strategic managerial decisions. The questions of how and why competitive market forces influence management practices are the focus of this paper. Using data on management practices from 152 New Zealand manufacturing firms, and competition data obtained for various industries of the NZ economy, we examine the association between different dimensions of competition and management practices. Notably, we find little or no association between better management practices and competition when utilising simpler measures of competition, namely the number of competitors, industry concentration measured by HHI and the price-cost margin are used. However, using a more refined measure of competition, competition intensity characterised by profit elasticity, has a positive and significant association with the quality of management practices adopted by firms. [ABSTRACT FROM AUTHOR]

Using a qualitative descriptive design, researchers describe andidentify similarities and differences in the professional preparation of infant-toddler care and education (ITCE) teachers at university based teacher education programmes in Hong Kong China, Aotearoa New Zealand, and the USA. Researchers overview the ITCE landscape, describe statutory regulations, and consider major documents and prevalent ideas influencing ITCE teacher education in their respective countries. Key findings are presented from each researcher's analysis of the teacher education programmes at their own institutions and then summarised in descriptive narratives around four major themes: (1) country-specific values, (2) pedagogical elements, (3) curriculum focus, and (4) teaching practicum expectations. On the basis of a dialogic deliberative process, the three researchers then discuss the findings together by deliberating upon how culture in the forms of norms, values, prevailing beliefs, and expectations, appeared to – intentionally or unintentionally – shape the three different approaches to preparing students to become fully-qualified teachers of infants and toddlers. [ABSTRACT FROM AUTHOR]

Attitudes and values (A + V) are an important component of the New Zealand physical education (PE) curriculum. These A + V have a strong synergy with the philosophy of Olympism and New Zealand is recognised as one of the few countries to link these constructs in a national curriculum statement. While these two constructs are linked, little is known about graduating teachers’ knowledge of them. This study set out to understand the graduating teachers’ knowledge of A + V in the national PE curriculum and that of Olympism. The study identified that there was variability between primary and secondary students’ knowledge of the curriculum’s A + V and the philosophy of Olympism. Conclusions include the suggestion that there are some inadequacies that need addressing in present Initial Teacher Education (ITE) programs. It recommends that a more systematic approach be adopted drawing on a critical tradition to address the explicit teaching of combining A + V and the philosophy of Olympism within present ITE PE programs. [ABSTRACT FROM AUTHOR]

Circular economy (CE) provides an alternative development model to the dominant take-make-dispose linear approach, and thus a new vision for solving sustainability challenges. Firms need to operationalise CE in their supply chain operations, starting from circular product design as the foundational step. The purpose of this paper is to investigate how to integrate product design and supply chain management (SCM) decisions for a CE transition. A thematic analysis was conducted on data collected from 15 semi-structured interviews in New Zealand. Four propositions were established based on the identified themes, namely, end-of-life thinking in product design, circular SCM, business model innovation, and sustainable organisational values. The study results provide a novel insight into the integration of product design and SCM for a CE transition. The operational framework developed provides guidance to product designers, managers, and researchers to advance the CE cause at the supply chain level. [ABSTRACT FROM AUTHOR]

Summary: This article reviews the risk equations recommended for use in international cardiovascular disease (CVD) primary prevention guidelines and assesses their suitability for use in Australia against a set of a priori defined selection criteria.The review and assessment were commissioned by the National Heart Foundation of Australia on behalf of the Australian Chronic Disease Prevention Alliance to inform recommendations on CVD risk estimation as part of the 2023 update of the Australian CVD risk assessment and management guidelines.Selected international risk equations were assessed against eight selection criteria: development using contemporary data; inclusion of established cardiovascular risk factors; inclusion of ethnicity and deprivation measures; prediction of a broad selection of fatal and non‐fatal CVD outcomes; population representativeness; model performance; external validation in an Australian dataset; and the ability to be recalibrated or modified.Of the ten risk prediction equations reviewed, the New Zealand PREDICT equation met seven of the eight selection criteria, and met additional usability criteria aimed at assessing the ability to apply the risk equation in practice in Australia. [ABSTRACT FROM AUTHOR]

Background: New Zealand went into lockdown March 2020 successfully eliminating the circulation of the coronavirus disease 2019 (COVID‐19) virus. During lockdown there were reduced rates of respiratory infections and hospital admission numbers were low. At the time, rumours of benefit and harm of medicines for COVID‐19 were widespread in the lay and medical media. Aim: To describe changes in inpatient prescribing in an acute general medicine service during the New Zealand COVID‐19 lockdown in 2020. Methods: Rates of prescribing of medicines during the 33 days of lockdown were compared with a 33‐day control period before lockdown. Prescriptions, patients and bed days were calculated from the hospital patient administration and electronic prescribing and administration systems. Results: In the general medicine service, acute admissions were 20% lower during lockdown (from 1216 pre‐lockdown to 974). There was a small decrease in the rate of prescriptions per patient (10.1 vs 10.4, P = 0.01) during lockdown, and the average length of stay was shorter (3.2 vs 3.6 days). Nebulised administration decreased by 75% (1.3% vs 5.3% of admissions) but unexpectedly there was no change in the prescribing rates of antibacterial medicines, e.g. amoxicillin (26% vs 26%). There were no changes in rates of prescribing of medicines being rumoured to potentially improve (e.g. hydroxychloroquine) or worsen (e.g. angiotensin‐converting enzyme inhibitors) COVID‐19 outcomes. Conclusions: Acute medical admissions decreased 20% during lockdown for COVID‐19, with a proportional decrease in prescriptions. Reduced rates of respiratory tract infections did not lead to decreased prescribing of antibacterial medicines. Rumour‐based prescribing did not eventuate. [ABSTRACT FROM AUTHOR]

Introduction: Image reject analysis (RA) in direct digital radiography (DDR) is an important quality indicator tool. Analysis of rejected images is a component of quality assurance (QA) programmes, with the overall aim of reducing patient radiation dose. This study aimed to compare differences in image rejection rates (RR) and the reasons for rejection between two radiology departments. Methods: A retrospective quantitative descriptive study of images performed across the two radiology departments (RAD 1 and RAD 2) acquired with DDR systems between the beginning of February and the end of May 2021 was undertaken. Collected data included the medical imaging technologist (MIT) selection of image rejection reasons for different anatomic regions and compared between the two radiology departments. Results: A total of 47,046 images and 29,279 images were acquired at RAD 1 and RAD 2, respectively, with an overall image rejection rate of 7.86% at RAD 1 and 5.91% at RAD 2. The primary reason for image rejections was positioning errors, 79.4% and 77.3% recorded at RAD 1 and RAD 2, respectively. Significant differences were demonstrated between the two radiology departments for image rejection rates and selected reasons for rejection for most anatomical body groups. Conclusion: The implementation of image RA remains a key part of QA in radiology departments utilising DDR systems. This study recommends interventions based on image RRs for examinations taking into consideration the department‐specific variations and imaging protocols used. [ABSTRACT FROM AUTHOR]

Background: Central venous access device (CVAD) is a common procedure in ICU which, although generally safe, can lead to acute and delayed complications. Training and accreditation process for its insertion vary worldwide. Aims: The objective of this study was to explore variability in existing training and accreditation processes for central venous access device (CVAD) insertion among different intensive care units (ICU), current practices of CVAD insertion among fellows of the College of Intensive Care Medicine (CICM) working in Australia and New Zealand (ANZ) and their recommendations for improvement. Methods: A prospective cross‐sectional web‐based survey was sent through email and CICM e‐newsletter to intensivists and directors of ICU across ANZ. All responses were tabulated, post‐hoc exploratory analysis using multivariable ordinal logistic regression was used and free texts were analysed thematically and summarised. Results: A total of 115 responses was received from various public and private ICU from all states of ANZ; 32% of the participants did not have any accreditation process for CVAD insertion skill in their ICU, whereas 91% of respondents revealed there were no processes to assess deskilling. Most intensivists recommended supervision, simulation, various education tools and ultrasound training to improve training and assessment. Thirty‐five percent of the participants inserted 0–5 CVAD and more than half of the intensivists had inserted <10 CVAD in a 1‐year period. Two‐thirds of the respondents recommended inserting between 6 and 20 CVAD each year to maintain competence. Conclusion: The study identified wide variability in current practice, training methods and accreditation process for CVAD insertion among intensivists and ICU trainees in ANZ. Policy makers should consider revising the current clinical practice and training policies to new policies for accreditation and ongoing assessment for CVAD insertions across ANZ ICU. [ABSTRACT FROM AUTHOR]

Background: Cancer cachexia (CC) is a debilitating syndrome severely impacting patients' quality of life and survivorship. We aimed to investigate the health care professionals' (HCPs') experiences of dealing with CC. Methods: Survey questions entailed definitions and guidelines, importance of CC management, clinician confidence and involvement, screening and assessment, interventions, psychosocial and food aspects. The online survey was disseminated through Australian and New Zealand palliative care, oncology, allied health and nursing organisations. Frequencies were reported using descriptive statistics accounting for response rates. Associations were examined between variables using Fisher's exact and Pearson's chi-square tests. Results: Over 90% of the respondents (n = 192) were medical doctors or nurses. Over 85% of the respondents were not aware of any guidelines, with 83% considering ≥ 10% weight loss from baseline indicative of CC. CC management was considered important by 77% of HCPs, and 55% indicated that it was part of their clinical role to assess and treat CC. In contrast, 56% of respondents were not confident about managing CC, and 93% believed formal training in CC would benefit their clinical practice. Although formal screening tools were generally not used (79%), 75% of respondents asked patients about specific symptoms. Antiemetics (80%) and nutritional counselling (86%) were most prescribed or recommended interventions, respectively. Conclusion: This study underlines the deficiencies in knowledge and training of CC which has implications for patients' function, well-being and survival. HCP training and a structured approach to CC management is advocated for optimal and continued patient care. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID‐19) in immunocompromised patients can lead to severe and prolonged illness. Data are limited with regard to management of COVID‐19 in this setting, particularly in persistent or recrudescent infection. The authors conducted an online survey among infectious diseases doctors to determine current approaches to treatment across Australasia. There was marked variability in responses relating to the diagnostic modalities and use of antiviral agents in patients with immunocompromise, highlighting the need for high‐quality studies to guide treatment decisions in this group. [ABSTRACT FROM AUTHOR]

Most residential buildings in New Zealand are low-rise light timber-framed (LTF) buildings, constructed according to a prescriptive standard – NZS 3604:2011 Timber-framed buildings. NZS 3604:2011 tabulates the seismic demand and also specifies the test procedure for evaluating the seismic resistance of proprietary LTF walls, which are often plasterboard walls. Designers need to ensure the provided total seismic bracing capacity is at least equal to the total seismic bracing demand, provided that bracing arrangements satisfy the specified irregularity limits. The irregularity limits of bracing arrangements in NZS3604:2011 were established based on engineering rules of thumb rather than rigorous scientific evidence. Earthquake damage observed in the 2010/11 Canterbury earthquake sequence demonstrated that simple regular LTF houses performed well while irregular houses often had significant damage that was uneconomical to repair. This suggested that the irregularity of LTF buildings was an important factor responsible for the exacerbated earthquake damage. To quantify seismic effects of permissible irregularities in NZS 3604:2011 and provide scientific evidence for elaborating irregularity limits in NZS 3604:2011, three single storey LTF buildings with varying degrees of permissible plan irregularities were designed and their seismic performance was studied by conducting three-dimensional non-linear push-over analyses. For the non-linear push-over analyses, the in-plane behaviour of LTF walls and ceiling diaphragms were modelled using the models, developed based on NZ practice, as reported in previous research. The study revealed that permissible irregular bracing arrangements in NZS 3604:2011 could amplify lateral deflections significantly, in comparison with the regular counterparts. As a result, irregular LTF buildings within the scope of NZS 3604:2011 could be susceptible to damage due to excessive deformations in earthquakes and this suggests that the irregularity limits in current NZS 3604:2011 be reviewed and tightened. [ABSTRACT FROM AUTHOR]

The New Zealand public service performs comparatively very well internationally and this has been evident during the global Covid-19 pandemic. The public service will need strong and adaptable leadership in future to respond effectively to significant global challenges and threats to public trust, and the need for better public policy responses to extant 'wicked' problems. The pandemic response in New Zealand and internationally provides strong pointers as to what New Zealand should do to develop public service leaders for the future. [ABSTRACT FROM AUTHOR]

Background: Facilitated implementation of nurse-initiated protocols to manage fever, hyperglycaemia (sugar) and swallowing difficulties (FeSS Protocols) in 19 Australian stroke units resulted in reduced death and dependency for stroke patients. However, a significant gap remains in translating this evidence-based care bundle protocol into standard practice in Australia and New Zealand. Facilitation is a key component for increasing implementation. However, its contribution to evidence translation initiatives requires further investigation. We aim to evaluate two levels of intensity of external remote facilitation as part of a multifaceted intervention to improve FeSS Protocol uptake and quality of care for patients with stroke in Australian and New Zealand acute care hospitals. Methods: A three-arm cluster randomised controlled trial with a process evaluation and economic evaluation. Australian and New Zealand hospitals with a stroke unit or service will be recruited and randomised in blocks of five to one of the three study arms—high- or low-intensity external remote facilitation or a no facilitation control group—in a 2:2:1 ratio. The multicomponent implementation strategy will incorporate implementation science frameworks (Theoretical Domains Framework, Capability, Opportunity, Motivation – Behaviour Model and the Consolidated Framework for Implementation Research) and include an online education package, audit and feedback reports, local clinical champions, barrier and enabler assessments, action plans, reminders and external remote facilitation. The primary outcome is implementation effectiveness using a composite measure comprising six monitoring and treatment elements of the FeSS Protocols. Secondary outcome measures are as follows: composite outcome of adherence to each of the combined monitoring and treatment elements for (i) fever (n=5); (ii) hyperglycaemia (n=6); and (iii) swallowing protocols (n=7); adherence to the individual elements that make up each of these protocols; comparison for composite outcomes between (i) metropolitan and rural/remote hospitals; and (ii) stroke units and stroke services. A process evaluation will examine contextual factors influencing intervention uptake. An economic evaluation will describe cost differences relative to each intervention and study outcomes. Discussion: We will generate new evidence on the most effective facilitation intensity to support implementation of nurse-initiated stroke protocols nationwide, reducing geographical barriers for those in rural and remote areas. Trial registration: ACTRN12622000028707. Registered 14 January, 2022. [ABSTRACT FROM AUTHOR]

Aim: We aimed to combine Global Burden of Disease (GBD) Study data and local data to identify the highest priority intervention domains for preventing cardiovascular disease (CVD) in the case study country of Aotearoa New Zealand (NZ). Methods: Risk factor data for CVD in NZ were extracted from the GBD using the "GBD Results Tool." We prioritized risk factor domains based on consideration of the size of the health burden (disability-adjusted life years [DALYs]) and then by the domain-specific interventions that delivered the highest health gains and cost-savings. Results: Based on the size of the CVD health burden in DALYs, the five top prioritized risk factor domains were: high systolic blood pressure (84,800 DALYs; 5400 deaths in 2019), then dietary risk factors, then high LDL cholesterol, then high BMI and then tobacco (30,400 DALYs; 1400 deaths). But if policy-makers aimed to maximize health gain and cost-savings from specific interventions that have been studied, then they would favor the dietary risk domain (e.g., a combined fruit and vegetable subsidy plus a sugar tax produced estimated lifetime savings of 894,000 health-adjusted life years and health system cost-savings of US$11.0 billion; both 3% discount rate). Other potential considerations for prioritization included the potential for total health gain that includes non-CVD health loss and potential for achieving relatively greater per capita health gain for Māori (Indigenous) to reduce health inequities. Conclusions: We were able to show how CVD risk factor domains could be systematically prioritized using a mix of GBD and country-level data. Addressing high systolic blood pressure would be the top ranked domain if policy-makers focused just on the size of the health loss. But if policy-makers wished to maximize health gain and cost-savings using evaluated interventions, dietary interventions would be prioritized, e.g., food taxes and subsidies. [ABSTRACT FROM AUTHOR]