Whakatane Hospital

Examine the access to the Bay of Plenty rehabilitation service for Indigenous Māori patients undergoing total knee arthroplasty (TKA). Identify structural aspects of the rehabilitation service which promote or restrict access for Māori. All patients who underwent TKA in publicly funded Bay of Plenty hospitals in 2021 were retrospectively supplied with a survey. Participants were asked to self-report demographic information and to complete a structured record of the duration, type, and location of their pre and post-operative rehabilitation. Māori patients accessed more rehabilitation (mean = 9.75 total hours) than non-Māori patients (mean = 8.34 total hours). This was in large part driven by a significant home-based component of their rehabilitation (42.9% of Māori respondents received at least some of their rehabilitation at home, compared to 16.4% of non-Māori). Once engaged with the orthopaedic service and having undergone TKA, rehabilitation access for Māori is comparable to if not greater than that of non-Māori. This is in large part driven by home-based rehabilitation. Practical facilitators which negate transport and financial barriers are an effective method of promoting access to health services for Māori.

Carpometacarpal joint (CMCJ) dislocations are a rare presentation and a volar dislocation in a pediatric patient even more so. We present a case of this condition along with management strategies to help guide future treatment of this injury. A fit and well 8-year-old boy presented with pain and deformity of his right hand following a fall from a horse. He had no history of previous trauma or injury to this hand. X-rays demonstrated a volar dislocation of the second CMCJ, along with several metacarpal base fractures. This injury was managed emergently with closed reduction in the Emergency Department and then underwent definitive treatment through percutaneous Kirschner wire (K-wire) fixation 2 days after injury. At 3- month follow-up, the patient and his family reported no pain, and on examination, there was no deformity and he had excellent range of motion. The patient had already returned to horse riding with no issues. A volar carpometacarpal dislocation in a pediatric patient is an uncommon presentation. We were able to achieve a full functional recovery using a mixture of closed reduction and K-wire fixation techniques. This clinical experience offers several learning points and also guidance around management strategies for future presentations of this condition.

Abstract Introduction Clinical guidelines are associated with improved patient outcomes. This is especially true for junior staff members with little clinical experience. We created Pocket Guidelines for the management of surgical patients in ED, aimed at house officers. Method Seventeen common surgical conditions were selected for guidelines. Information was collated on presentation, exam findings, differential diagnosis, laboratory tests, imaging, indications for referral, and timing. Evidence based guidelines were approved by General Surgical consultants in the department. The utility of our guidelines was assessed by surveying 20 junior doctors. Results 16 out of 20 house officers responded to the survey, ranging from post graduate year (PGY) 1 to 4, majority of them (37.5%) being PGY1. 69% were female and 31% were male. A 5- point Likert scale was utilised for answers. No house officers ‘strongly agreed’ with being confident in managing surgical conditions in ED. Over 80% strongly agreed with the need to have ED clinical guidelines for surgical patients. Over 90% of house officers, having studied the pocket guidelines, found these useful. Conclusions We implemented pocket guidelines for general surgery in a rural hospital ED to streamline surgical admissions. Guidelines were found to be beneficial by the majority of junior doctors.

Pulmonary herniation is defined as protrusion of lung parenchyma through thoracic wall weakness. We present a case of a 69-year-old male who presented to a rural hospital with a 4-day history of cough, right-sided chest pain and exertional shortness of breath. His past medical history included right lung adenocarcinoma treated with right upper lobe lobectomy via video-assisted thorascopic surgery (VATS) 3 years prior. Chest inspection revealed decreased chest wall movements on the right side with no visible chest bulge and on palpation non-tender chest bilaterally with palpable crepitus of the right anterior chest. Chest expansion was reduced on the right side associated with hyper-resonant percussion. Auscultation revealed diffuse bilateral rhonchi. A CT of the chest showed herniation of the right lung through a post-operative defect in the thoracic wall. The patient was initiated on codeine linctus for cough suppression and remained haemodynamically stable for his 3-day admission. He remained asymptomatic at his 4-week follow up with complete resolution of surgical emphysema. We could find no other case reports of VATS lobectomy where lung herniation presented years after surgery.

Glazing and window systems in New Zealand have been shown to be susceptible to significant damage as evidenced by the past decade of earthquakes. The seismic performance of glazing and window systems has resulted in considerable financial loss, disruption in business and physical injuries following earthquakes. In order to investigate the vulnerability of residential windows in typical light timber framed buildings racking testing was conducted on six wall configurations. Numerous observations of window performance were made during the testing and from these results fragility functions were developed for timber and aluminium framed windows. These fragility functions suggest that even at low displacement levels damage can occur to windows that can potentially affect weather-tightness and require repairs following an earthquake. These functions can inform decisions around designing for resiliency in residential structures in New Zealand.

To determine factors leading to delay between referral by the GP of symptomatic patients and subsequent specialist diagnosis of colon or rectum cancer (CRC). A retrospective audit of patients with new CRC referred by their GP over a 30-month period to the specialist services. Analysis of referral letters, specialist grading and subsequent results of investigations. We focused on the High Index of Suspicion (HIS) criteria for suspected CRC. Only 65 out of 181 patients fulfilled the HIS criteria and of these only half were correctly identified in the referral letter. Only 48 who fulfilled HIS criteria were graded as urgent by the specialist and had their fast-track diagnostic test within a median of 21 days (5-114). The remaining 133 waited a median of 67 days (10-387) (p<0.001). The diagnosis was reached faster if the patient went straight to colonoscopy rather than initial outpatient assessment: median 32 versus 81 days (p=0.008). The HIS Urgent pathway only identified a third of patients and so the criteria should be reviewed. GPs frequently failed to recognise and refer those who met the criteria. A standardised referral form prompting the inclusion of all required information would improve this.

ABSTRACTThree independent scientific lines of evidence were sought to determine the nutrient load limits to safeguard the macrophyte community of an intermittently closed and open lake/lagoon (ICOLL): (1) a literature review identified nitrogen load thresholds related to the collapse of macrophytes in similar systems in Australia, Europe and elsewhere, (2) an ICOLL expert carried out an assessment based on current local data and on data from 57 Australian coastal lakes and lagoons, and (3) a deterministic coupled hydrodynamic-ecological model was developed and applied to simulate the ecological outcomes of several nutrient loading scenarios. The three lines of evidence converged on well-defined nitrogen load estimates required to avoid the collapse of the macrophyte community. Uncertainties were slightly greater in relation to required phosphorus load limits, but the evidence still helped set a precautionary phosphorus load limit that accounted for these uncertainties. Thus, despite the challenges in setting load limits for complex ecosystems, multiple lines of evidence helped derive robust nutrient load limits for managing the ICOLL to safeguard values associated with a healthy macrophyte community.