The New Zealand medical journal
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CT pulmonary angiography (CTPA), D-dimer testing, and pre-test probability scoring have greatly improved the ability to manage patients with suspected pulmonary embolism. International guidelines suggest combining these investigations for the best yield. We have been investigating the use of CTPA in patients with suspected pulmonary embolism (PE) admitted to the Department of General Medicine at Christchurch Hospital, New Zealand. ⋯ There was a very low uptake of the formal use of pre-test probability scores by medical registrars. This audit confirms that, in patients with low or moderate risk of PE and a negative D-dimer, an alternative diagnosis should be considered. The management of suspected venous thromboembolism (VTE) could be improved; it is likely that after hours CTPA could be reduced.
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To examine a representative series of adverse events in New Zealand public hospitals where death was the final outcome recorded, with a view to determining the relationship between adverse event and death. ⋯ Because of the nature of the record review procedure used in the New Zealand Quality of Healthcare Study, a finding of death did not necessarily mean that an adverse event and death were causally related. Indeed, it is possible that extrapolations of mortality rates in this and other similar studies over-estimate by about a half the number of deaths caused by healthcare management.
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To review the management and outcome of patients presenting with acute biliary pain/cholecystitis, mild acute pancreatitis, or cholangitis to a major New Zealand (NZ) metropolitan hospital. ⋯ The management of acute gallstone-related disease at a major NZ metropolitan hospital fails to meet with current international standards. Few patients undergo index cholecystectomy, and a large proportion of those treated conservatively return to the health sector with ongoing problems.
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A case of cutaneous larva migrans is presented. The patient acquired the parasite in a suburban Christchurch property. ⋯ It is rare in New Zealand, however. Presumably there were very specific, favourable local factors to allow maturation and transmission of the larva in this case.
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Carotid endarterectomy (CEA) under local or regional anaesthesia is being considered more often by vascular surgeons to improve cerebral monitoring and to reduce general anaesthetic complications. The purpose of this study was to audit the results of CEA under regional anaesthesia in a New Zealand hospital (Dunedin Hospital, Otago Province). ⋯ CEA under regional anaesthesia is a safe operation even in patients with coronary disease and in a low volume setting. Moreover, it allows monitoring of cerebral ischaemia and the safe use of selective shunting. The results are comparable to other recently published series and provide a baseline for comparison with newer treatment modalities.