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Introduction: Patients undergoing radiation therapy have a diverse range of information needs, however, there is a lack of data specific to the needs of New Zealand patients. This cross‐sectional survey captured New Zealand cancer patients' preferences for radiation treatment information. Preferences were assessed regarding the scope of information needs and the satisfaction with which these needs were being met. Methods: A custom survey was offered to 275 eligible patients undergoing radiation treatment at six of 10 departments across New Zealand over a 2‐day period. The survey captured patient demographics as well as information needs and satisfaction across five distinct domains using Likert scales and one free‐text question. Responses were analysed using descriptive statistics and directed content analysis. Results: Over 80% of participants rated all information domains as extremely or very important. Over 90% of participants were extremely satisfied or very well satisfied in four of the five domains. Information on what happens after radiation treatment had the lowest satisfaction at 78%. No demographic subcategories were clearly associated with differences in information needs or satisfaction. 59% of participants indicated their willingness to engage in online education. The qualitative analysis strongly corroborated the quantitative results. Conclusion: The New Zealand cancer patients surveyed in this study demonstrated high levels of importance and satisfaction with the information provided during radiation treatment. Information on what happens after completing radiation treatment had the lowest satisfaction. These findings support further exploration of New Zealand cancer patients' information needs following radiation treatment as well as strategies to address them. [ABSTRACT FROM AUTHOR]

Objectives: To explore the unique impact the first COVID‐19 national lockdown in New Zealand (NZ) had on the utility of computed tomography (CT)‐head scanning in patients presenting to the ED with head injuries. Methods: Retrospective observational study of CT‐head use in head‐injured patients presenting to the ED during the 2020 COVID‐19 lockdown compared to the corresponding time period in 2019. Results: During the lockdown period in 2020, the total number of ED presentations reduced by 30.3% (95% confidence interval [CI] 28.8–31.6) from 13 477 to 9403. The total number of head injury presentations also reduced by 32% (95% CI 27–36.7) from 523 to 356. The proportion of head‐injured patients remained similar (3.9% [n = 523] in 2019 vs 3.8% [n = 356] in 2020). Of the head injured patients, 185 (51.9%, 95% CI 44.5–59.4) had CT‐head scans performed in 2020 compared to 269 (51.4%, 95% CI 45.2–57.5) in 2019; a reduction of 31.2% (95% CI 24.5–37.9). The proportion of patients who had a CT‐head scan remained similar (51.4% [95% CI 45.2–57.5] in 2019 vs 51.9% [95% CI 44.5–59.4] in 2020). There were no significant differences in the proportion of CT‐head scans with acute traumatic pathology (13.0% [95% CI 8.7–17.3] in 2019 vs 12.4% [95% CI 7.4–17.5] in 2020, P = 0.86). Conclusions: During the first COVID‐19 lockdown in NZ, the total number of patients presenting to the ED decreased by one third. Reassuringly, the proportion of patients who presented with head injuries, had a CT‐head scan performed, and had positive CT‐head findings remained the same as the previous year. [ABSTRACT FROM AUTHOR]

Introduction: This research assessed the preparedness of new graduate radiation therapists (NGRTs) for the clinical practice of planning. Methods: A senior planner from each department and NGRTs who completed their degree in 2020 were surveyed after approximately 6 months of practice. Both were asked about NGRTs preparedness for practice and for feedback on the Bachelor of Radiation Therapy (BRT) planning curriculum. NGRTs were asked about body sites planned, how many plans they completed and planning techniques they had used. Senior planners were asked about their expectations of NGRTs in planning. Results: New graduate radiation therapists frequently planned using three-dimensional conformal radiation therapy (3DCRT) or virtual simulation (VSim). Commonly planned body sites were those with palliative intent, radical breast and sites more frequently planned using 3DCRT. The departmental sign-off process sometimes prevented them from generating VMAT plans. They suggested more VMAT teaching could be included in the BRT. Senior planners expected NGRTs to be able to plan using 3DCRT and VMAT/IMRT. They suggested more clinical workflow teaching in the BRT planning curriculum. The majority of NGRTs and senior planners felt the BRT prepared the NGRTs for clinical practice. Conclusion: The undergraduate degree is preparing NGRTs for clinical practice in planning. 3DCRT and VSim planning techniques remain a core role of NGRTs and a large proportion of clinical workload. NGRTs utilised their VMAT/IMRT planning skills less often during their initial period of practice, despite being expected to possess these skills. This is a challenge for the undergraduate curriculum and New Zealand departments as the clinical use of VMAT/IMRT continues to increase. [ABSTRACT FROM AUTHOR]

Introduction: The use of CT head scanning for traumatic brain injury (TBI) is a vital diagnostic tool, guided by risk stratification tools. This study aims to review the use of CT head scans and adherence to guidelines for TBI in two New Zealand emergency departments (EDs). Methods: Retrospective observational study of patients referred for head CT from EDs to exclude a significant intracranial injury between 1st September 2018 and 31st August 2019. Clinical data were collected regarding presenting patterns, identification of injuries on CT scan and adherence to National Institute of Clinical Excellence (NICE) CT head guidelines. Results: Out of 425 included cases, 41 (10%) patients had an intracranial injury seen on their CT head scan. Patients who reported loss (32% vs 20%, p < 0.05) or possible loss of consciousness (34% vs 22%, p < 0.05) and had a Glasgow Coma Score (GCS) <13 (17% vs 8%, p < 0.05) or focal neurology (10% vs 3%, p < 0.05) were more likely to have an intracranial injury on CT. Interestingly, 17 (41%) patients with CT diagnosed injuries had a GCS 15 and no focal neurology. NICE guidelines were adhered to in 364 (86%) of CT requests. In the 14% of cases that did not meet guideline criteria, all CT head scans were negative. Conclusion: CT head scans are a valuable tool in TBI, and guidelines successfully identify those with significant intracranial injuries. However, the rate of significant injury for the total population requiring head CT remains low, with over 90% of head CTs in the population normal, despite high guideline compliance, perhaps identifying a role for novel objective tests in ED guidelines internationally. [ABSTRACT FROM AUTHOR]

Objective: There is limited research from Australasian EDs describing the demographic make‐up, injury severity and impact of alcohol in patients requiring computed tomography (CT) for suspected traumatic brain injury (TBI). The present study aims to review the frequency and presenting patterns of patients who consume alcohol prior to presenting with suspected TBI. Methods: Retrospective observational study of patients referred for head CT to exclude TBI from a major referral centre and regional ED in New Zealand, between 1 September 2018 and 31 August 2019. Comparison groups were defined as 'alcohol involved' or 'no alcohol involved'. Results: 97/425 (22.8% [95% CI 18.3–27.4]) of included TBI presentations involved alcohol. 73/97 (75.3% [95% CI 58.6–93.5]) were male and 41/97 (42.3% [95% CI 29.3–55.2]) were aged 18–30 years. The alcohol group were more likely to report assault as the injury mechanism (19.6% [95% CI 10.8–28.4] vs 5.2% [95% CI 2.7–7.7], P < 0.05) and have Glasgow Coma Scale scores reflecting more moderate (13.5% [95% CI 5.9–21.1] vs 3.5% [95% CI 1.5–5.6]) and severe (5.6% [95% CI 0.7–10.5] vs 3.2% [95% CI 1.2–5.2] TBI. Presentation times post‐injury were delayed compared to the no alcohol group (3.4 h [interquartile range 1.9–14.8] vs 2.8 h [interquartile range 1.8–6.6], P < 0.05). Conclusion: One quarter of patients with suspected TBI had consumed alcohol prior to their injury. Predominantly, those affected were young males who reported higher rates of assault; however, alcohol use was recorded in all age groups and sex. Alcohol‐affected patients presented later, potentially delaying time to diagnosis. The present study supports the call for public health interventions that aim to reduce alcohol misuse. [ABSTRACT FROM AUTHOR]

Current cardiovascular risk screening approach in airline pilots in New Zealand (NZ) does not fully achieve the goal of identifying silent cardiovascular disease (CVD) before it causes sudden incapacitating symptoms. Moreover, approaches to investigate excessive cardiovascular risk relied heavily on exercise electrocardiography as a diagnostic test, and were sub-optimal to either detect disease, or to protect pilots from unnecessary invasive procedures. This paper recommends a new approach in assessing CVD in asymptomatic pilots in NZ. The assessment of a 5-year cardiovascular risk score using NZ cardiovascular risk charts as currently adopted will still be the first step of the screening process. The new approach is that asymptomatic pilots with 5-year CVD risk of 5-10% and 10-15% will be referred for coronary artery calcium scoring. No further cardiovascular investigations will be required if the calcium score is <400. Those with a calcium score between 100 and 399 will receive drug and/or lifestyle interventions. Pilots with a calcium score of ≥400 will proceed to a stress myocardial perfusion imaging or a coronary computed tomography angiography. Those with a normal result will not undertake further examination and will receive lifestyle and/or drug interventions. If an abnormal result is found, the pilots will undergo a coronary angiography, and a definitive treatment such as percutaneous coronary intervention might be recommended. After consideration of the risks and benefits of cardiac tests involved, the proposed new system appears to be reasonable and feasible to be implemented in the cardiovascular risk assessment of asymptomatic pilots. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: ICD lead failure is a potential source of significant morbidity and mortality. This study investigates the survival rates of Sprint Quattro, Endotak Reliance, and Linox ICD leads. Methods and results: A retrospective cohort study of all patients with an ICD implanted between January 2007 and December 2012 from the Wellington Hospital region, New Zealand, a tertiary referral center. Lead and patient details were established by review of clinical notes and the PaceArt Optima database. We analyzed a total of 287 implants using Sprint Quattro (n  =  92), Endotak Reliance (n  =  37), Linox (n  =  151), Riata (n  =  4), and Sprint Fidelis (n  =  2) leads. Median follow‐up was 61.6 (26.0–81.6) months for Sprint Quattro leads, 66.7 (53.3–88.8) months for Linox leads, and 82.9 (45.9–107.4) months for Endotak Reliance leads. There were 20 cases of lead failure of which 19 were in Linox leads. The 4‐, 6‐, and 8‐year survival for Linox leads was 97% (92.6–99.1), 93% (85.5–96.5), and 76% (62.3–85.5), respectively. The predominant abnormality was detection of nonphysiological electrical signals. Linox lead failure was associated with a younger age of patient (49.2 vs. 57.7 years, P  =  0.007). Conclusions: The 7‐year survival of Linox leads was significantly worse than shown in Biotronik surveillance reports, but in line with other single‐center studies from around the world. [ABSTRACT FROM AUTHOR]

Background Acute scrotal pain is a urological emergency due to the possibility of testicular torsion and subsequent testicular loss if correction is not carried out in a timely manner. Methods We conducted a retrospective review of all patients who underwent surgical exploration for acute scrotal pain in a provincial hospital in New Zealand between 1 January 2001 and 31 December 2010. Results A total of 91 cases were identified. The median delay pre-hospital was 9 h and in-hospital was 2.5 h. Patients who had a non-viable testicular torsion and patients under the age of 14 had longer pre-hospital delays of 24 and 72 h, respectively. In-hospital delays were similar between all pathologies except for non-viable testicular torsions with 7 h and 45 min. Viable testicular torsions had a median in-hospital delay of 2 h and 13 min. Conclusion Delay from the time of testicular pain until surgical exploration is important for the chances of testicular salvage and is made up mostly of pre-hospital delays. Patients under the age of 14 had longer delays pre-hospital. [ABSTRACT FROM AUTHOR]

Objectives The first extended care paramedic ( ECP) model of care in New Zealand was introduced in the Kapiti region, north of Wellington in 2009. The ECP model aimed to increase the proportion of patients presenting to the ambulance service who could be treated in the community. This study evaluated the first 1000 patients seen by ECPs. Methods The first 1000 presentations attended by ECPs were examined to determine the proportions of patients transported to the ED and treated in the community. For patients treated in the community we determined the number presenting to the ED within 7 days of ECP attendance. Results A total of 797 patients (mean age 62 years) had 1000 clinical presentations. In 59% the patient was treated either at home or in the local community, with 40% transported to the ED. Within the same region and time period 74% of patients attended by standard paramedics were transported to the ED. The rate of ECP transport to the ED differed significantly by clinical condition, with 71% of cardiac presentations versus 19% of patients with spinal problems taken to the ED. In 31 cases (5%) where the patient had been managed in the community there was an acute ED presentation within 7 days. Conclusion We observed that ECPs have significant potential to reduce hospital ED attendances by treating more patients in the community, and this is associated with a low rate of subsequent ED presentations. Prioritisation of dispatch of ECPs to particular types of patients might be useful in maximising this reduction. [ABSTRACT FROM AUTHOR]

Objective: A patient satisfaction survey was undertaken in the Kapiti District of the Wellington Region to ascertain patients' experience and opinions of New Zealand's first extended care paramedic (ECP) service before consideration is given to extending it to other locations within the region. Patient outcomes were also analysed for 1 week following ECP care. Methods: One hundred patients, 50 attended by ECPs and 50 by standard emergency ambulance service paramedics, were interviewed by an independent assessor, either in person or by phone according to patient preference. The questionnaire was aimed at comparing the experience of both groups of patients, dividing them into those treated at home and those transferred to the ED. ED and general practice records were then reviewed to determine whether the ECP-treated patients attended either facility within 7 days and why. Results: Patients were very satisfied with their experience of both groups of paramedics but expressed a clear desire to be treated at home if possible. Of the 50 ECP-treated patients, 11 were transferred directly to the ED. Only one clinical complication arose over the next 7 days in those treated in the community: a seizure in a patient with refractory epilepsy. Conclusion: The avoidance of unnecessary transfers to hospital is beneficial to patients, the ambulance service and the ED. This study demonstrates that patients are very satisfied with their assessment and treatment by ECPs, endorsing the proposal that the scheme should be extended across the Wellington Region, and perhaps New Zealand. [ABSTRACT FROM AUTHOR]

Summary: Recent studies have found that poor cardiopulmonary resuscitation (CPR) is commonly performed in resuscitation attempts, both by health professionals and lay people. One of the contributing factors to poor performance of CPR may be poor initial teaching. This study was conducted to investigate the quality of 14 CPR courses complying with New Zealand Qualifications Authority standards, which includes formal assessment of CPR. While courses taught by the large first aid training organisations in New Zealand had a student to manikin ratio of around 3:1, courses taught by smaller providers had a ratio of over 4:1. During the 4h course, only 20±2min were spent demonstrating CPR, and 26±4min were spent with students practising CPR. The assessment of adult, child and infant CPR took on average less than 2.5min in total. Importantly, in the majority of courses (71%), certification was granted when the CPR technique was performed incorrectly, with both compression depth and compression place being corrected only 57% of the time. Courses only discussed the importance of early defibrillation 57% of the time, and provided limited information on symptoms of acute coronary syndromes. In light of these observations it is suggested that the current style of teaching is unlikely to result in students being able to perform adequate CPR if required in the community. [Copyright &y& Elsevier]

Background: To date, there has been no detailed study of the risk factors and clinical characteristics of patients presenting with myocardial infarction (MI) at a young age in our region. The purpose of this study was to assess the rate and clinical profile of those presenting with young MI in New Zealand.Methods: We identified a cohort of 1199 patients presenting with acute MI between January 2012 and November 2015 from the Wellington Acute Coronary Syndrome Registry. We compared those presenting with young MI, defined as presentation with MI aged 50 years or younger, to those aged over 50 years.Results: Myocardial infarction at a young age occurred in 154 (12.8%) patients. Compared to those in the older MI group, the young MI group were more likely to be male (80% vs. 71%, p=0.026), of Maori or Pacific Island ethnicity (21% vs. 10%, p<0.0001), have a higher BMI (31kg/m2 vs. 29kg/m2, p<0.0001), have a family history of premature coronary artery disease (49% vs. 34%, p<0.0001) and to be current smokers (47% vs. 20%, p<0.001). Young MI patients were less likely to have hypertension, dyslipidaemia and diabetes than the older MI patient population. Within the young MI group 36% had none or only one traditional risk factor for MI, and would have been classified as low risk prior to their index event.Conclusion: Those with young MI accounted for 12.8% of our cohort and had a different risk factor profile to the older MI group with smoking and obesity being particularly prevalent. [ABSTRACT FROM AUTHOR]

Background: We examined equity of access to implanted cardioverter defibrillators (ICDs) in New Zealand in 2010 by district health board (DHB), ethnicity and socioeconomic status. Methods: All new ICD recipients in 2010 were examined according to home district health board, ethnicity according to the national health database, and socioeconomic status using the NZDep index. Results: During 2010, 352 new ICDs were implanted nationwide, giving an overall implantation rate of 80.6/million. However, implant rates varied significantly across the 20 DHBs with the highest implant rate observed in Tairawhiti at 192.3/million, and the lowest at 22/million in the Nelson region. There was also significant variation in implant rate by ethnicity, with Maori ethnicity at an implant rate of 114/million, European patients at 83/million, Pacific Island patients at 47/million and Asian patients an implant rate of 32/million. There was no significant difference in number of implants by socioeconomic decile. Conclusions: The variance in implantation rate by district health board and by ethnicity suggests that access to ICD therapy is not equitable in New Zealand. Investigation into causes of inequity of access is required. [ABSTRACT FROM AUTHOR]

Abstract: Aims: The effect of cardiopulmonary resuscitation guideline changes on out-of-hospital survival rates and defibrillation efficacy was investigated. The guideline changes were those recommended by the International Liaison Committee on Resuscitation in 2005. Methods: A retrospective comparative study was undertaken of out-of-hospital cardiac arrests in the Wellington region. The effect of guideline changes between the periods of 1st July 2005–30th June 2006 and 1st June 2007–31st May 2008 was examined. Data was collected from Wellington Free Ambulance and hospital records in accordance with the Utstein template. The primary outcome measure was survival to hospital discharge. Additional end points included individual shock success, return of spontaneous circulation (ROSC) and survival to hospital admission. Results: There was no significant increase in survival to hospital discharge with 11% (18/162) pre-change and 12% (20/170) post-change (p =0.5). First-shock efficacy decreased from 68% (65/96) to 62% (57/92) (p =0.75). Second shock efficacy decreased from 47% (14/30) to 27% (9/33) (p =0.12). The proportion of patients with ROSC increased from 34% (55/162) to 42% (72/170) (p =0.07, Chi squared). The proportion surviving to hospital increased significantly from 22% (36/162) to 36% (61/170) (p =0.006). Withdrawal of atropine in 2005 had no adverse effect on the outcome. Conclusion: This study suggests that in the Wellington Region of New Zealand, the new guidelines have improved survival to hospital but not to discharge. Whilst the guideline changes have resulted in a trend towards decreased shock success rates, ROSC and survival to hospital admission have both increased. [ABSTRACT FROM AUTHOR]