Notes

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Differences between supportive and non-supportive OTD attitudes was seen for some questions.

Findings highlight areas for strategic OTD public engagement and provide details relevant to guiding appropriate clinical interaction in facilitating decisions about OTD.
Findings highlight areas for strategic OTD public engagement and provide details relevant to guiding appropriate clinical interaction in facilitating decisions about OTD.
The surgical management of trauma is an important aspect of training in general surgery. The aim of this study is to assess the current levels of experience in trauma management and attitudes towards adequacy of exposure amongst current trainees in New Zealand.

An anonymous survey assessing experience in trauma management posted to all New Zealand general surgical trainees in Surgical Education and Training (SET) years two to five.

21 of 62 trainees responded. There was little correlation between SET levels or months of registrar experience and number of operations performed, which ranged from 0 to 22. 81% of trainees felt their exposure to trauma operations was inadequate. The average supervision rate for operating was 73%. The majority of trainees showed an interest in trauma with 76% replying yes, with four answering maybe, and one no. 100% of trainees felt that training in trauma was at least somewhat important.

Experience and training in trauma care is very important but currently inadequate to allow the safe delivery of surgical treatment for injured patients by well-trained surgeons. Surgical training needs to be reorganised, using all available clinical and simulation resources to ensure this critical skills area is maintained for all trainees.
Experience and training in trauma care is very important but currently inadequate to allow the safe delivery of surgical treatment for injured patients by well-trained surgeons. Surgical training needs to be reorganised, using all available clinical and simulation resources to ensure this critical skills area is maintained for all trainees.
Estimating Primary Health Organisation (PHO) enrolment rates with a census-derived estimated resident population denominator may provide misleading results because of numerator and denominator mismatch. This study uses the Health Service Utilisation (HSU) population denominator as an alternative.

A HSU population was generated by record linkage of routinely collected datasets from the Ministry of Health via encrypted National Health Index (NHI). We compare PHO enrolment rates by age and ethnicity in Counties Manukau District Health Board (CMDHB) in 2013.

In CMDHB, 98% of people who had utilised publicly-funded health services in 2013 were enrolled in a PHO in 2013. Using the HSU population as a denominator, PHO enrolment rates for Maaori, Pacific, Asian, New Zealand European/Other population groups were 98.3%, 97.7%, 97.6%, and 98.3% respectively. Just under 4% of people discharged from CMDHB inpatient facilities were not enrolled in a PHO within a month from the day of discharge in 2013.

Using the HSU population as a proxy of health services need, PHO enrolment rates were similar across ethnicities in the CMDHB population. Support to improve PHO enrolment coverage would be more efficient if the HSU population were used to target people who are not yet enrolled in a PHO.
Using the HSU population as a proxy of health services need, PHO enrolment rates were similar across ethnicities in the CMDHB population. Support to improve PHO enrolment coverage would be more efficient if the HSU population were used to target people who are not yet enrolled in a PHO.
Communication failures in healthcare are frequent and linked to adverse events and treatment errors. Simulation-based team training has been proposed to address this. We aimed to explore the feasibility of a simulation-based course for all members of the operating room (OR) team, and to evaluate its effectiveness.

Members of experienced OR teams were invited to participate in three simulated clinical events using an integrated surgical and anesthesia model. We collected information on costs, Behavioural Marker of Risk Index (BMRI) (a measure of team information sharing) and participants' educational gains.

We successfully recruited 20 full OR teams. Set up costs were NZ$50,000. Running costs per course were NZ$4,000, excluding staff. Most participants rated the course highly. BMRI improved significantly (P = 0.04) and thematic analysis identified educational gains for participants.

We demonstrated feasibility of multidisciplinary simulation-based training for surgeons, anesthetists, nurses and anaesthetic technicians. The course showed evidence of participant learning and we obtained useful information on cost. There is considerable potential to extend this type of team-based simulation to improve the performance of OR teams and increase safety for surgical patients.
We demonstrated feasibility of multidisciplinary simulation-based training for surgeons, anesthetists, nurses and anaesthetic technicians. The course showed evidence of participant learning and we obtained useful information on cost. There is considerable potential to extend this type of team-based simulation to improve the performance of OR teams and increase safety for surgical patients.
The aim of this study was to explore medical decision-making practices at the end-of-life made by GPs (MDEL) in New Zealand and to identify changes in practice with a previous study published in 2004.

A postal questionnaire was sent to 3,420 GPs in New Zealand in May 2013. Anonymous phone interviews were also undertaken. BTK inhibitor Analysis of the questionnaire was done on IBM SPSS Statistics 21.

There was a 21% response rate from two mail outs. Of the 650 GPs who responded, 547 had contact with a patient prior to death and had the potential to make a MDEL. Of these, 359 (65.6%) reported making a MDEL. Of the 359 GPs who reported making a MDEL, 16 (4.5%) attributed death to a drug that had been prescribed, supplied or administered explicitly for the purpose of hastening the patient's death. The alleged involvement of nurses in practices that intentionally hasten death is high.

Our study shows that some GPs have explicitly assisted their patients to die, that nurses are allegedly involved, and there is a tendency towards more discussion with patients about MDEL.
Our study shows that some GPs have explicitly assisted their patients to die, that nurses are allegedly involved, and there is a tendency towards more discussion with patients about MDEL.This special article defines the public health principles and core public health functions that are combined to produce the public health services essential for a highly-functioning New Zealand health system. The five core functions are health assessment and surveillance; public health capacity development; health promotion; health protection; and preventive interventions. The core functions are interconnected and are rarely delivered individually. Public health services are not static, but evolve in response to changing needs, priorities, evidence and organisational structures. The core functions describe the different ways public health contributes to health outcomes in New Zealand and provide a framework for ensuring services are comprehensive and robust.The special article on 'Core public health functions for New Zealand' by Williams and colleagues in this issue of the Journal is a very valuable contribution to public health thinking in this country. The inter-relationships between goals, outcomes sought, core functions and key principles are all well outlined. The valuable illustrative examples in their Table 2 indicate the depth of experience and thinking by the authors.We report on a friction study at the nanometer scale using atomic force microscopy under electrochemical control. Friction arises from the interaction between two surfaces functionalized with cyclodextrin molecules. The interaction is mediated by connector molecules with (ferrocenylmethyl)ammonium end groups forming supramolecular complexes with the cyclodextrin molecules. With ferrocene connector molecules in solution, the friction increases by a factor of up to 12 compared to control experiments without connector molecules. The electrochemical oxidation of ferrocene to ferrocenium causes a decrease in friction owing to the lower stability of ferrocenium-cyclodextrin complex. Upon switching between oxidative and reduction potentials, a change in friction by a factor of 1.2-1.8 is observed. Isothermal titration calorimetry reveals fast dissociation and rebinding kinetics and thus an equilibrium regime for the friction experiments.The formation of self-assembled contacts between vapor-liquid-solid grown silicon nanowires and flat silicon surfaces was imaged in situ using electron microscopy. By measuring the structural evolution of the contact formation process, we demonstrate how different contact geometries are created by adjusting the balance between silicon deposition and Au migration. We show that electromigration provides an efficient way of controlling the contact. The results point to novel device geometries achieved by direct nanowire growth on devices.
In two investigations, we identified explicitly relational supervision strategies and examined whether use of these strategies was associated with perceptions of the supervisory alliance and evaluations of the supervisor.

First, ratings by nine supervision researchers identified five clearly relational in-session strategies (focus on countertransference, exploration of feelings, attend to parallel process, focus on the therapeutic process, focus on the supervisory alliance) in the Critical Events model of supervision. Based on these expert ratings, we created and assessed the Relational Behavior Scale (RBS).

Analyses with two samples of supervisees at all levels of training supported the measure's reliability and factorial validity. The RBS's validity was further indicated by its unique association with the "interpersonally sensitive" style of supervision. In both studies, supervisees perceived more frequent use of relational behavior on the part of psychoanalytic/psychodynamic/humanistic supervisors than cognitive-behavioral supervisors. Moreover, as hypothesized, supervisors' use of relational behavior in a specific session mediated the association between trainees' alliance perceptions and evaluations of their supervisors in that session.

The identification of specific in-session supervision behaviors that explain one way in which a strong alliance contributes to trainees' positive experiences of their supervisors has implications for supervision theory, research, and practice.
The identification of specific in-session supervision behaviors that explain one way in which a strong alliance contributes to trainees' positive experiences of their supervisors has implications for supervision theory, research, and practice.Overexpression of the oncogene HER2 occurs in 20-30% of invasive breast cancer and is associated with poor prognosis. A number of different splice variants of HER2 have been identified which produce functionally different proteins. Previously these splice variants have been investigated separately, but in the present study we collectively look at the expression and regulation of a group of HER2 splice variants produced by a splicing hotspot. Initial investigation in a cohort of tumor samples showed large variations in HER2 variant expression between patient samples. RNA interference studies identified 2 splicing factors involved in the regulation of splicing within this region, hnRNP H1 and SRSF3. siRNA targeting hnRNP H1 increases levels of X5 and the oncogenic variant Δ16HER2. Furthermore RNA chromatography assays demonstrated binding of hnRNP H1 to RNA in this region. Additionally the proto-oncogene SRSF3 was also identified as an important regulator of splicing with SRSF3 knockdown resulting in changes in all the splice variants located at the hotspot.
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