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Issue 115 - 27 October 2009

≈ 'Glimpses through History'  2010 Pictorial Calendar ≈
Photographs of nurses over the last 100 years - at work and at play, in meetings and on the streets protesting against health cuts, overseas during war time and mopping ward floors in the 1950s - feature in NZNO’s new centennial calendar.
$10.00 each plus postage of 1.50 - includes gst)

To order a calendar, please post your cheque made out to NZNO, with your full name, postal address and phone number to:
Lynette Kirby
New Zealand Nurses Organisation
National Office
PO Box 2128


1. Evolving role of ultrasound in the emergency department
by Thompson, Peter. Emergency Medicine Australasia, Oct 2008, Vol 20 Issue 5: p375-378
The article presents the critical role of ultrasound in the emergency department clinical practice and looks forward to innovative uses of ultrasound. The Australasian College for Emergency Medicine (ACEM) actively supports the development of bedside ultrasound. Much has been achieved following its original policy produced in 1999 regarding its use, which was revised in 2006.

2. Opiates and acute pulmonary oedema: Addicted to the wrong therapy
by Hermann, Luke & Jagoda, Andy. Emergency Medicine Australasia, Oct 2008, Vol 20 Issue 5: p379-381
The author presents a comment on the article of M. A. Sosnowski titled "Lack of Effect of Opiates in the Treatment of Acute Cardiogenic Pulmonary Oedema." The author relates that there is a dearth of good evidence to help guide the management of acute decompensated heart failure (ADHF) patients. He added that the most reasonable argument for using opiates in acute pulmonary oedema(APO) is that they do possess some vasodilatory properties that might potentially improve cardiac output.

3. More biomarkers for risk stratification of chest pain: Bigger, faster, better?
by Parsonage, William A. Emergency Medicine Australasia, Oct 2008, Vol 20 Issue 5: p382-383
The article presents a study that seeks to circumvent chest pain by using an earlier and extended panel of biomarkers to identify patients at low risk of acute coronary syndrome (ACS). The inclusion of myoglobin to the biomarker panel measured only 2h following admission identified all patients who were subsequently found to have elevated troponin levels at 12h. Moreover, stress testing has been shown to provide incremental and cost-effective benefits beyond the use of electrocardiogram.

4. Review article: Lack of effect of opiates in the treatment of acute cardiogenic pulmonary oedema
by Sosnowski, Marcin A. Emergency Medicine Australasia, Oct 2008, Vol 20 Issue 5: p384-390
Opiates have traditionally been used as one of the main treatments of acute heart failure and are still recognized as such. Most current textbooks and official guidelines advise the use of morphine as one of the first-line treatments for patients in acute cardiogenic pulmonary oedema and a majority of physicians accept it to be the case. The author performed an extensive literature search in order to validate the evidence for the use of opiates in this condition. A total of seven papers, six in English and one in Polish, were found that directly investigated or reported the clinically important outcomes of treatment of acute pulmonary oedema. Only five of these dealt specifically with the effects of administration of opiates in acute cardiogenic pulmonary oedema. None of the above publications suggested a clinically significant improvement in outcomes of patients treated with morphine, although early research did suggest reduced anxiety, blood pressure and pulse rate as well as a reduction in arterial oxygen contents. The more recent studies suggest a strong
association between increased mortality and morbidity (e.g. intensive care unit admissions or intubation rates), although causality is difficult to establish because of research methodologies. The current evidence does not support the routine use of opiates in the treatment of acute pulmonary oedema. [ABSTRACT

5. Review article: Amphetamines and related drugs of abuse
by Greene, Shaun L et al. Emergency Medicine Australasia, Oct 2008, Vol 20 Issue 5: p391-402
Acute amphetamine toxicity is a relatively common clinical scenario facing the Australasian emergency medicine physician. Rates of use in Australasia are amongst the highest in the world. Clinical effects are a consequence of peripheral and central adrenergic stimulation producing a sympathomimetic toxidrome and a spectrum of central nervous system effects. Assessment aims to detect the myriad of possible complications related to acute amphetamine exposure and to institute interventions to limit associated morbidity and mortality. Meticulous supportive care aided by judicial use of benzodiazepines forms the cornerstone of management. Beta blockers are contraindicated in managing cardiovascular complications. Agitation and hyperthermia must be treated aggressively. Discharge of non-admitted patients from the emergency department should only occur once physiological parameters and mental state have returned to normal. All patients should receive education regarding the dangers of amphetamine use. [ABSTRACT FROM AUTHOR]

6. Rapid risk stratification in suspected acute coronary syndrome using serial multiple cardiac biomarkers: A pilot study
by Macdonald, Stephen P & Nagree, Yusuf. Emergency Medicine Australasia, Oct 2008, Vol 20 Issue 5: p403-409
To determine the feasibility of using a biomarker panel of myoglobin, creatinine kinase MB (CK-MB) and cardiac troponin I (cTnI) to identify patients with suspected acute coronary syndrome (ACS)who are suitable for discharge within 2 h.
Methods: We took blood at presentation and at 2 h from patients with suspected ACS and non-diagnostic electrocardiogram who were admitted to the ED short stay ward for serial electrocardiogram and troponin testing. We used a point-of-care device that gives rapid estimation of myoglobin, CK-MB and cTnI (Triage cardiac panel). These results were compared with the results of our standard hospital cardiac troponin T assay. Patients were followed up by telephone at 30 days.
Results: The study group comprised 100 patients (61 men) with mean age of 58 years. Six had a troponin-positive ACS during their ED stay. One additional patient died of a myocardial infarction within the follow-up period. The Triage panel at 2 h after presentation predicted 12-h cardiac troponin T elevation (sensitivity 100%, negative predictive value 99%) and 30-day events (sensitivity 86%, negative predictive value 97%). The majority of patients were ultimately suitable for discharge.
Conclusion: Serial myoglobin, CK-MB and cTnI have the potential to identify patients who are suitable for early discharge and outpatient work-up. A large multicentre study is required. [ABSTRACT FROM AUTHOR]

7. Implementation of a guideline for computed tomography head imaging in head injury: A prospective study
by Fong, Christina et al. Emergency Medicine Australasia, Oct 2008, Vol 20 Issue 5: p410-419
To improve appropriate ordering of head computed tomography (CT) in patients presenting with a head injury by applying an evidence-based head injury guideline.
Methods: This was a comparison observational study of CT head ordering in the setting of head trauma between two groups of patients. There was a pre-guideline implementation group and a post-guideline implementation group. Our Southern Health Head Injury Guideline was largely based on the Canadian CT Head Rule by Steill et al. 2001.We also applied the Canadian CT Head Rule to our post-guideline implementation group.
Results: CT ordering rate in the pre-guideline group was 31.6%compared with 59% in the post-guideline group with a relative risk of 1.88 (95% confidence interval [CI]: 1.56–2.27). Abnormal head CT were reported in 6.8% in the pre-guideline group and 5% in the post-guideline group (relative risk 0.88, 95% CI 0.44–1.51). When we applied the Canadian CT Head Rule to the prospective group, four patients with clinically significant abnormal head CT would not have been scanned. The sensitivity of the guideline was 100% (95% CI 79–100%), with a specificity of 43.22% (95% CI 37–48%) in diagnosing a significant head injury on CT.
Conclusion: The Southernhealth Head Injury Guideline is safe and easy to apply to minor and major head injuries. [ABSTRACT FROM AUTHOR]

8. Computerized tomography of the brain for elderly patients presenting to the emergency department with acute confusion
by Hardy, James Edward & Brennan, Nicholas. Emergency Medicine Australasia, Oct 2008, Vol 20 Issue 5: p420-424
Confusion is a common reason for presentation of elderly patients to the ED. There are many potential causes of confusion, which include acute neurological events. Computerized tomography (CT) scans are often routinely ordered to investigate confusion, despite the recommendation of guidelines against routine use. The aim of the present study was to determine the usefulness of CT brain scans in a prospective cohort of confused elderly patients presenting to an ED.
Methods: The progress notes of 106 consecutive patients over 70 years of age who had a CT brain scan for a presentation of acute
confusion were reviewed for indications for the scan and the presence of neurological examination findings. Official radiology reports of CT brain scans were assessed for the presence of abnormalities.
Results: Of the 106 patients, 12 (11%, 95% CI 5.29–17.35) had no documented neurological examination. Fifteen patients (14%, 95% CI 7.51–20.79) had acute abnormalities on CT scan, one of whom had two abnormalities. There were ten acute ischaemic strokes, four cerebral haemorrhages and two meningiomas. Thirteen of the patients with positive CT findings (93%, 95% CI 80.7–105.96) had new findings on neurological examination. The only patient with no neurological findings with a positive CT scan had had a fall. A history of a fall or the presence of neurological findings on examination was predictive of a positive CT scan (odds ratio 17.07, 95% CI 2.15–135.35).
Conclusion: The results add further support to guidelines that suggest that CT scans of the brain for confused elderly patients should only be performed for those with acute neurological findings, head trauma or a fall. [ABSTRACT FROM AUTHOR]

9. Junior doctor strike model of care: Reduced access block and predominant Fellow of the Australasian College for Emergency Medicine staffing improve emergency department performance
by Thornton, Vanessa; Hazell, Wayne. Emergency Medicine Australasia, Oct 2008, Vol 20 Issue 5: p425-430
To describe the response and analyse ED performance during a 5-day junior doctor strike.
Methods: Data were collected via the patient information management computer system. Key performance indicators included percentage seen within maximum waiting times per triage category (TC), ED length of stay, emergency medicine patients who did not wait to be seen, hospital bed occupancy and access block percentage. Comparisons were made for the same 5 days before the strike (BS), during the strike (S) and after the strike.
Results: Total doctor's shifts BS were 78.66 with 25% of these shifts being Fellow of the Australasian College for Emergency Medicine (FACEM) shifts. FACEM shifts were more common during the S period at 75% ( P < 0.001). Total attendances (BS 631 vs S 596, P = 0.22) and TC percentages ( P-values for TC 1, 2, 3, 4, 5, respectively, 1.0, 0.55, 0.88, 0.97, 0.46) in the BS, S and after-the-strike periods were not significantly different. Despite fewer total doctor shifts, the FACEM predominant model of care during the strike resulted in better percentages seen within the maximum waiting times for TC3 (66%), TC4 (78%) and TC5 (86%) (all P < 0.001). There was a reduction in patients who did not wait to be seen (28 BS vs 5 S, P < 0.001), ED length of stay (admissions: BS 451 min vs S 258 min, P < 0.001; discharges: BS 233 min vs S 144 min, P < 0.02) and referrals to inpatient services ( P = 0.02). This occurred with reduced bed point occupancy of 66% and a consequent reduction in access block.
Conclusion: FACEM staffing and reduced access block were significant factors in improved ED performance. [ABSTRACT FROM AUTHOR]

10. Paediatric short stay unit in a community hospital: Effective, efficient and popular
by Hopper, Sandy M et al. Emergency Medicine Australasia, Oct 2008, Vol 20 Issue 5: p431-436
Short stay medicine is a cost-effective and efficient way to manage patients with suitable conditions. Paediatric acute illness and injury are amenable to short stay medicine. Before January 2004, when Maroondah Hospital recommenced inpatient care for children, 700 children were transferred annually to other hospitals. We describe the implementation and performance of the first paediatric short stay unit (SSU) in Victoria, which was designed to remedy this situation.
Methods: Set in a 291-bed metropolitan hospital, we audited paediatric emergency attendances, admissions, transfers and discharges. We present quality and consumer satisfaction data.
Results: The environment was designed for the physical, developmental and social needs of children. We implemented education, a system of exclusion criteria and pathways to enhance safety. Over 12 months, of 9097 paediatric attendances, 1101 required inpatient care. Among them, 862 patients were admitted to the SSU and 239 were transferred. Accordingly, 78% of admitted patients were cared for in-house. Median length of stay was 20 h. Of the 708 reviewed cases, there were 19 (3%) unexpected transfers from the SSU, 59 (8%) long stays (>48 h) and no deaths. Via a telephone survey, there were 30/355 (8%) unplanned representations and satisfaction data were overwhelmingly positive. We suggest that this model is suitable for centres with limited paediatric cover. In-house senior emergency physician cover might be preferable to an after-hours junior staff-only model.
Conclusion: A co-located paediatric SSU within an ED is an efficient, popular and viable alternative for paediatric services to be delivered in a suburban setting. [ABSTRACT FROM AUTHOR]

11. Cardiac arrhythmia during propofol sedation
by Douglas, Robert J & Cadogan, Mike. Emergency Medicine Australasia, Oct 2008, Vol 20 Issue 5: p437-440
: Recent articles have described the increasing frequency of use of propofol as a sedating agent in the ED, and praise the safety profile of propofol when used in this manner. We describe a patient who developed torsade de pointes followed by ventricular fibrillation while undergoing propofol sedation for closed reduction of a mid-shaft fracture of the tibia and fibula. Possible reasons for the event are discussed, and suggestions are made for are as of further research. [ABSTRACT FROM AUTHOR]

12. Difficult diagnosis in the emergency department: Hyperemesis in early trimester pregnancy because of incarcerated maternal diaphragmatic hernia
by Ting, Joseph Yuk Sang. Emergency Medicine Australasia, Oct 2008, Vol 20 Issue 5: p441-443
Hyperemesis gravidarum is a frequent presentation to the ED, which usually resolves with fluid rehydration and antiemetics. Early incarcerated maternal diaphragmatic hernia might be misdiagnosed as relatively benign hyperemesis gravidarum in the first two trimesters of pregnancy. Diagnosis is missed because of non-specific presentation with abdominal pain, nausea and vomiting. Hernias rarely become symptomatic even in latter stages of pregnancy, as the uterus increases in size with each trimester and with raised intra-abdominal pressure from uterine contraction during labour. Symptoms progress with incarceration and strangulation of abdominal contents within the thoracic cavity, compression of the lung and disruption of caval venous return. A woman at 19-week gestation presented with delayed diagnosis of strangulated diaphragmatic hernia, representing the earliest gestation in the published literature when this has occurred. She had repeatedly been misdiagnosed with hyperemesis gravidarum. It is worthwhile considering incarcerated maternal diaphragmatic hernia as an unusual cause of refractory vomiting in pregnancy, when associated with clinically significant upper abdominal pain and progressive respiratory embarrassment. This might occur as early as the mid-second trimester, and without uterine contraction. [ABSTRACT FROM AUTHOR]

13. Associate Professor Andrew Dent, AM
by Phillips, Georgina. Emergency Medicine Australasia, Oct 2008, Vol 20 Issue 5: p444-446
An obituary for Associate Professor Andrew Dent is presented.

Journals – Table of Contents

14. From nursing.aust,Winter 2009, Vol 10 No 2
Moving Forward [Tracey Osmond, Chief Executive - On 2 September the College of Nursing and the Royal College of Nursing, Australia joined in celebrating our 60 years of achievement in nursing education and professionalism]
14B. Meet John Kemsley, Director Education Services
14C. Joy Vickerstaff, Orator 2009 [Profiles her qualifications and achievements in nursing and midwifery]
14D. The inaugural College of Nursing Oration, 1953 [The changing scene in health work throughout the world, delivered by Miss M.I Lambie]
14E. One year on [The McGrath Foundation continues Jane's legacy]
14F. NHHRC final report - A summary [The final report of the National Health and Hospitals Reform Commission was released by the Prime Minister, Kevin Rudd, on 27 July 2009]
14G. Restoring the fabric of Australian nursing history: veiled lives [A social history of Australian World War One nurses]
14H. What nursing students do [Sia Charles, Student, School of Nursing and Midwifery, Flinders University, South Australia]
14I. Expand your career options [A collaboration between Southern Cross University and The College of Nursing]
14J. Contemporary issues: Learning and change in healthcare
14K. "Everything is on the internet ... and free" [Graham Spooner, Manager, Library Services, College of Nursing explains that that's not quite true]
14L. College Alumni
14M. A tale of two colleges [The College of Nursing and the RCNA celebrate 60 years of nursing achievement]
14N. Library News [All about Nursing Consult has e-journals and e-books]

15. From JONA (The Journal of Nursing Administration), October 2009, Volume 39, Number 10

15A. Wicked problems in designing healthcare facilities
15B. A case study in evaluating infrastructure for EBP and selecting a model
15C. Teaching levels of evidence: the Santa project
15D. Online knowledge networking: What leaders need to know
15E. Improvements in disaster planning and directions for nursing management
15F. Career mapping: Developing nurse leaders, reinvigorating careers
15G. Outcomes achieved from organizational investment in nursing continuing professional development
15H. The impact of electronic medical records on nursing efficiency
15I. Nursing is not just emotion; Knowing and Leadership; Continuing Education; Caring and Contingency Staffing; A Caring Enterprise; Some final comments

Conferences, training and seminars

16. 8th edition of Med-e-Tel (“Call for Abstracts”
Seminars, demonstrations and interactive panel discussions on ehealth, telemedicine and ICT applications in medicine and healthcare.
14th -16th April, 2010
Venue: Luxembourg
Abstracts can now be sent in “online”:

17. Nursing Research Section NZNO Conference
Celebrating Nursing Research: Opening Doors
November 20 & 21st, 2009
Venue: Duxton Hotel and Conference Centre, Wellington

News – National

18. Court staff walk out over pay talks
NZPA - 27/10/09
More than 1,700 Justice Ministry staff walked off the job for an hour at 10am. The strike is an escalation of industrial action that began last Wednesday with a "work to rule" over stalled pay talks.

19. Doctors' handwashing targeted
The Press - 27 Oct 2009
A hygiene campaign for health professionals begins in Canterbury next month as Australian research shows inadequate handwashing by most doctors.New research published in the Medical Journal of Australia found nurses were better than doctors and other health workers at handwashing.

20. Fears for elderly as home-care hours cut
ODT - 22 Oct 2009
Grey Power is concerned a reduction in home-care services might be adversely affecting some elderly people who previously received a higher level of service, Grey Power New Zealand health spokesman Dick Stark, of Gore, says.

21. Death during swine flu 'hysteria' probed
NZ Herald - 22 October 2009
The death of a Christchurch man from undiagnosed blood poisoning during the height of "swine flu hysteria" is being investigated by the Health and Disability Commissioner.

22. Health Services gap jars
ODT - 21 October 2009
Otago and Southland district health board members were yesterday shocked to learn a "virtual iron curtain" still existed between health services in Queenstown and Central Otago.

23. Too clean for our own good
Taranaki Daily News - 21 October 2009
New Zealanders are facing a growing epidemic of allergies and the cause might be a bath or two away. Auckland-based  allergy specialist Vincent St Aubyn Crump says scientists from around the  world are quoting the cleanliness  hypothesis, saying that those in  developed countries are, perhaps, too  hygienic.

24. Government set to announce DHB reforms
Stuff - 21 October 2009
The Government will today announce a new agency to look at moving back office functions of the country's 21 district health boards into a separate body.

25. Bowel cancer service review
ODT - 21 October 2009
The Southern Cancer Network will conduct an independent investigation into concerns raised by Otago general practitioners about access to colonoscopy services.

26. Drugged driving law now includes benzodiazepines
Stephen Joyce - 20 October, 2009
Parliament has tonight voted to widen the scope of new drugged driving legislation to include benzodiazepines - a class of prescription drugs that can lead to severe impairment in driving ability.

27. Medical-care bed covers all the bases
Taranaki Daily News - 19 October 2009
A hospital bed designed for intensive care use has just won a Taranaki company a prestigious design award. New Plymouth-based Howard Wright Ltd has picked up silver at the national BeST Design Awards. The company won its silver in the non-consumer product design category at the awards, which were announced in Auckland on Friday night.Howard Wright's M8 intensive care bed, developed in conjunction with healthcare professionals, is safe to use and requires minimal training and servicing.

28. Rural GPs not keen to join Southland PHO
The Southland Times - 19 October 2009
Rural GPs in Southland are not keen on joining a new Southland Primary Health Organisation, with some saying they hope to take their business to Otago.

29. Annual Report for the year ended 30 June 2009 including the Director-General of Health’s Annual Report on the State of Public Health
Date of publication: October 2009
Summary of publication:
This Annual Report outlines the Ministry of Health’s key achievements for the 2008/09 financial year, including the Ministry’s performance against the outcomes, key initiatives, outputs and measures set out in the 2008−11 Statement of Intent.

News - International

30. Backlash fear over 'diabetes disaster'
The Australian - October 27, 2009
DRUG giant Eli Lilly is facing a potential backlash over its funding of a report warning that Australia faces a diabetes "disaster", with experts concerned it could be seen as a marketing push to win public subsidies for a new medicine. The report released today warns an estimated 1.6 million Australians will be diagnosed with type 2 diabetes by 2050, and the disease will be costing the country $14 billion a year.,25197,26264726-23289,00.html

31. Gene therapy experiment restores sight in a few
Calgary Herald
PHILADELPHIA - Nine-year-old Corey Haas can ride

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