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A report on the general surgical workforce in New Zealand.  Analysis and predictions

Abstract

As part of the Trainee Intern year a health care evaluation project is undertaken.  Our group looked at the General Surgical Training Programme in New Zealand.  A number of variables were identified and explored that impact on General Surgical Training in New Zealand.  There was also a small descriptive study undertaken looking at the Training Programme and the outcomes of participants going through this.  From these a numerical model was constructed to estimate the number of General Surgeons needed in 2001.

We found that to keep the current General Surgeon: Population ratio (1:21613) it is necessary to provide 39 General Surgical Full Time Equivalents by the year 2001.  Because of the attrition rate in the Training Scheme this would mean 82 Trainees would have to enter the Scheme over the same time.  This would require an increase in both the number of trainees and training positions over current levels.

Authors of Report

Grant Meikle, Terry Mitchell, Coral Morris, Margaret Parle, Jeremy Sheard, Esther Willis, Roslyn Yeoman.

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An Evaluation of Hepatitis B and Rubella Antenatal Screening and Immunisation Programme

Abstract

Since 1985 it has been national policy for all infants of carrier mothers of hepatitis B to be offered hepatitis B immunisation and immune globulin, because these infants are at risk of vertical transmission and of becoming chronic carriers of hepatitis B.  There has been no national evaluation of this programme, so we do not know how well this policy is being implemented.

As the control of congenital rubella syndrome relies on ensuring that women are immune to rubella at the time of childbearing, one part of the policy is to test all women for rubella antibodies in early pregnancy, and to offer immunisation postpartum to susceptible women.  This policy has also not been evaluated nationally in recent years.  (There was some routine monitoring of the programme until 1988).

Aims

  1. To describe the process in place in New Zealand for antenatal screening for hepatitis B and rubella, and for postpartum immunisation of infant or mother.
  2. To determine the outcome of the antenatal screening and immunisation programmes in Dunedin in terms of –
    • Assessing the adequacy of antenatal HBsAg and Rubella screening in Dunedin Public Hospital
    • Determining the number of women delivering babies at Queen Mary Maternity Unit, Dunedin, over a three year period to April 1994, who were shown to be Hepatitis B surface antigen (HBsAg) positive, and/or Rubella antibody negative on routine antenatal screening, and assessing uptake of immunisation by those women and babies at risk, as per the national protocol.

Results

From a sample of women delivering at Queen Mary Maternity Unit, 100% received antenatal screening for hepatitis B antigen and rubella antibody.

For those women available to the study, who were HBsAg positive and/or rubella antibody negative, 100% received appropriate follow-up management.

Authors of Report

Kaaren Wood, Jamie Ryan, Fiona McCrimmon, Erfan Hedayati, Ainsley Goodman, Tom Eade, David Davies-Payne, Matt Bevin.

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Breath alcohol levels of hotel patrons in North Dunedin

Introduction

In New Zealand a large number of people enjoy the consumption of alcohol and do so responsibly.  However, there is a growing awareness that a small number of people persist in drinking excessively and irresponsibly and contribute out of proportion to alcohol related harm.  Host responsibility is a strategy aimed at promoting the responsible serving of alcohol and thus shifting the burden of the monitoring of responsible alcohol consumption for law enforcement authorities to all persons involved in the sale and supply of liquor and those involved in making decisions about a drinking environment.

The New Zealand “Host Responsibility” programme has developed from initiatives in Australia based on studies by Howat (1987), Stockwell et al (1992a, 1992b, 1993) and McKnight (1991).  These studies established factors important in the responsible serving and consumption of alcohol and form the basis of a similar programme in Australia.

The “Sale of Liquor Act (1989)” covers some of the above aspects of Host Responsibility as they apply to those involved in the sale and supply of alcohol and makes them legal requirements.  For example a host is required by law to provide non-alcoholic alternatives and food.  There are age restrictions on those who can be served and it is illegal to supply intoxicated persons with alcohol.

The National Guidelines on Host Responsibility (1991) require that licensed premises formulate an implement a policy on the responsible serving of alcohol.

A policy should include the provision of food which is available at all times with more substantial food available at mealtimes.  Low and non alcoholic drink alternatives should be provided and promoted.  This allows patrons more choice in what they drink and increased control of the level of alcohol drinking.

As young people are over-represented in our drink driving statistics it is important that a policy should include strategies for identifying minors and how minors should then be dealt with.

The study by McKim et al in Cancer J Public Health (1991) showed that drinking behaviours at an older age were set by drinking behaviour at an early age.  That is, those that established drinking patterns at a later age tended to drink less and more responsibly.  Thus the non-serving of under age patrons is also important in establishing responsible drinking patterns for future.

As already mentioned, it is illegal to serve an intoxicated person and a policy should include identification of those persons and refusal of service as well as dealing with those persons on the premises.  Host Responsibility encourages management to provide easy access to telephones and various schemes such as subsidized taxis or designated drivers to ensure safe homeward transport of patrons.

Host Responsibility programmes can only be successful if staff are trained.  A policy should include specifics about how it will orientate and train new staff and retain old staff plus how they will acknowledge or reward its implementation.

In-house promotions such as happy hours and two-for-one promotions encourage heavy drinking.  The policy should address and review practices that encourage heavy drinking behaviour.

Management are also encouraged to develop a policy on dealing with staff and their personal problems as well as channeling patrons with long term drinking problems into appropriate agencies for help.

National Guidelines for Host Responsibility are also available for private and workplace hosts.  Outlines for training are also included.

Since the establishment of “The National Guidelines for Host Responsibility”, it has been acknowledged by some groups (eg ALAC, NZ Police) that drinking behaviour has changed.  However, there has been no independent evaluation of this programme.  This study sets about, in a small way to evaluate the success of host responsibility and suggest areas for improvement.

Authors of Report

Elaine Jeffrey, Miriam Martin, Nua Tupai, Roko Waganisau, Catherine Walker, John Wilson, Lisa Wynne.

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Pulmonary Embolism:  As an indicator of the quality of health care

Introduction

Clinical Indicators are used as an objective measure of clinical management and outcome of care.  It is an objective measure of the process or outcome of patient care in quantitative terms.

Pulmonary Embolism development has been suggested for use as a possible clinical indicator to determine outcome for surgical services.  An Australian study suggested in 1991 a provisional threshold for Pulmonary Embolism development of 1% (for private and public hospitals) after surgery.  This implies that a hospital with a post-surgical Pulmonary Embolism development rate of 1% or less has “better quality” patient care than a hospital with a post-surgical rate of greater than 1%.

Within New Zealand the new climate of emphasis on quality and accountability in the health services, clinical indicators have become increasingly important as a tool for assessment of hospital care.  However, research has shown that many factors combine to influence clinical outcome, and this is no less true in the surgical services.  The question that we intend to answer is whether a hospital’s post-surgical Pulmonary Embolus development rate is an adequate measure of quality of its surgical services.

Authors of Report

M Andrews, B Bigwood, R Byars, A Carll, W Cheung, J Finlay, A Mark, M McKague.

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Sports injuries in the playground:  A review of Dunedin Intermediate and Secondary Schools

Abstract

Sport related accidents and injuries are a significant health problem in today’s schools.  This descriptive study of Dunedin’s Intermediate and Secondary schools endeavoured to look at the incidence of sport injuries in schools, and the high risk students and sports.  This study was unable to develop accurate, informative data due to the paucity of information recorded by schools.

However the policies schools have in place to deal with injuries and their ability to promote preventive measures were also addressed.

It was discovered that many schools have inadequate policies.  Inadequacies were discovered with respect to which staff members have first aid training, the first aid facilities available, the recording of injury information and the general hygiene and safety standards of the schools.

Recommendations have been made which will allow the schools to better recognize problematic areas resulting in injury and to deal better with the injuries once they have occurred.  Recognition of hazardous areas will allow the institution of preventive measures making schools a safer place to today’s students.

Authors of Report

Jan Hurring, Kerrie Knapp, Tim Marr, David Orr.

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The attitudes of health care professionals to immunisations

Abstract

This sixth year medical student project was carried out on behalf of the Medical Officer of Health and a General Practitioner.  The project was essentially to assess the attitudes of health care professions to immunisation.  A local postal survey was carried out involving practices, public health nurses, plunket nurses, midwives and general practitioners.  Response rates were greater than anticipated and were above 50% for all groups.

The findings have shown that most immunisations are administered by practice nurses and general practitioners, with public health nurses administering rubella and some polio vaccinations.  A small number of midwives are administering the six week vaccinations only.  In the local region plunket nurses do not administer immunisations. 

There was no significant difference in the sources of information used by the various groups, although three independent midwives rated the Immunisation Awareness Society as a very important sources of information.  One public health nurse and two practice nurses rated parents as very important sources of information.

There were no statistically significant differences between the groups in terms of attitudes towards immunisation.  All groups regarded the benefits of immunisation as outweighing the risks both for the population and the individual.

The survey showed that 100% of public health nurses, 68% of general practitioners, 63% of practice nurses and 30% of midwives had received postgraduate training on immunisation.  Plunket nurses, in the survey, all reported they had not had any postgraduate training in this field.

There was variability in recall systems among those administering immunisations, in terms of recall systems existing, and the impact they had made.

Authors of Report

Vivien Binney, Karen Cleveland, John Corboy, Tony Freeman, Anne Maloney.

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Would Santa go down this chimney?

Introduction

Outline of Objectives

We are a group of eight trainee inters who have been given the opportunity, as part of our Preventive and Social Medicine attachment, to look into some of the issues surrounding the granting, under the new Resource Management Act, of a resource consent to the Ravensdown Fertilizer Co-Operative Ltd (hereafter referred to as Ravensdown).

Under the previous legislation embodied in the Clean Air Act, Ravensdown had been granted rights to operate a fertilizer works in the Ravensdown area.  Since the beginning of operations there has been concern voiced by a variety of people over health and environmental issues surrounding the emissions that are released in the day to day running of the works.

The transition in legislation has provided these people with forum in which to voice their concerns.

Our brief was to collect and assimilate the relevant information, to listen to the viewpoints of all those involved, and to present an overview of the major issues involved, making any recommendations we felt to be constructive.

Authors of Report

Geoffrey Barton, Lloyd T Clarke, Marcus Fitchett, M Bartholomew McCabe, Janeen Milner, Iona Thomas, Justine Turnbull, Garry van der Veen.

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Young and Sick in the City

Abstract

A study was commissioned by Assoc. Prof. D. Holdaway of Dunedin Hospital Paediatric Department to attempt to determine the health needs of 14-18yr olds (inclusive) in the Dunedin area.  Overseas studies have suggested that 20% of young people in this age group have ongoing health problems.  To determine if the heath needs of this group were indeed being met, we conducted a three part study.  The first part involved the collation of data from the various services around Dunedin who dealt with young people.  The demographic and anecdotal data obtained suggested that this age-group was a significant user proportion of a number of these services.  In the second part, 146 young people were interviewed in school, university and social settings.  Subjects were questioned as to their health service requirements in the last 12 months.  They were asked to comment on service cost, value for money and general satisfaction of each facility utilised.  Subjects were also asked whether they were aware of the variety of services available to them.  Their thoughts on the status of current health services as well as suggestions for improvements were also recorded.  The third part of the survey involved consultation with a group of Dunedin experts of young peoples health needs.  They offered opinions and recommendations on improvements to the current services.  Results suggested that care specific to the needs of young people was lacking and that facilities that catered to the many problems specific to this age group needed to be established.

Authors of Report

C Andrews, T Clough, B Gerrard, E Harvey, E Hollow, R Hughes, A Keast, A Windfuhr.

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