WAIKATO CLINICAL SCHOOL FACULTY OF MEDICAL AND HEALTH SCIENCES UNIVERSITY OF AUCKLAND

ANNUAL REPORT 2011 Waikato Clinical School Annual Report 2011

Head of School Professor Ross Lawrenson

Deputy Head of School Associate Professor Peter Jones

School Manager Mrs Raewyn Wooderson

Research Coordinator Associate Professor John Conaglen

Head of Postgraduate Studies Dr Jacquie Kidd

Head of Undergraduate Teaching Dr Wayne de Beer

Academic Coordinator, Rotorua Dr Nic Crook

Names of Management Committee Members (for University Centres and Institutes) As above plus Professor Graham Mellsop Professor Jamie Sleigh

The Waikato Clinical School is an Academic Division of The University of Auckland, Faculty of Medical and Health Sciences. The School provides clinical teaching for undergraduate medical students and is involved in postgraduate training and research.

The main purpose of the School is to provide an outstanding environment in which medical students can undergo their clinical training. We aim to pursue excellence in teaching and learning through exposure of our students to high quality clinical teachers. The School is also committed to developing and increasing its research performance and the number and quality of its postgraduate students in line with The University of Auckland’s Strategy.

Our Mission Statement The Waikato Clinical School first and foremost aims to provide an excellent clinical learning environment for students. The School also aims to increase both its clinical and basic research and encourage increasing liaison with researchers in New Zealand and internationally.

Affiliations and Collaborations The Waikato Clinical School could not operate without the support and input from a number of key collaborators. In particular we need to recognise the considerable support we receive from the Waikato District Health Board. We also have strong links with Lakes and the Bay of Plenty DHB’s and Midlands Health Network.

Over the years the School has had considerable funding from the Waikato Medical Research Foundation.

Our History An agreement concerning the formation of the Waikato Academic Division, (renamed the Waikato Clinical School in 2001) was signed by Prof Peter Gluckman from the University of Auckland and Dr Tony Cull, Health Waikato CEO in 1994.

The school grew rapidly under the leadership of Dr Peter Rothwell and became a clinical teaching centre with an excellent reputation for providing clinical experience and a supportive environment for the students. In 2002 a new building incorporating the Clinical Skills Centre and the Library was opened and named the ‘Peter Rothwell Academic Centre’. Dr Rothwell was succeeded by Dr Jack Havill in 2003 and Prof Ross Lawrenson in 2005.

The Chief Executive Officer of the Waikato DHB from 1998 to 2005 was Dr Jan White who not only supported the Waikato Clinical School as a teaching centre but also supported research with the establishment of Chairs in Medicine, Anaesthetics, Psychiatry and Primary Health Care. This support for research has been continued by the current administration led by the CEO, Mr Craig Climo. The University of Auckland greatly values the strategic partnership with the Waikato DHB and formally signed a ‘Strategic Alliance Agreement’ in November 2005.

The Rotorua campus was started in 2003 with the placement of 12 trainee interns at Rotorua Hospital. In 2009 the Faculty of Medical and Health Sciences signed an agreement with the Bay of Plenty District Health Board. Waikato Clinical School 5th year students have the opportunity to spend some of their clinical time at both Rotorua and the Bay of Plenty Clinical School.

Undergraduate Students The purpose of the school is to provide an outstanding environment in which medical students can undergo their clinical training and to pursue excellence in teaching and learning through exposure to high quality clinical teachers. Medical students from The University of Auckland apply to undertake clinical training at the Waikato Clinical School and can be accommodated in most specialties in the 4th, 5th and 6th years of the course. “Selective” attachments are also available and there are a limited number of overseas elective students accepted each year. Trainee Intern positions are available at both the Waikato and the Rotorua Campuses. In 2011 we had 30 students at Waikato and 12 at Rotorua. Forty students were placed in the “Midland 5th Year Cohort” and students have had clinical attachments in Waikato, Rotorua and Tauranga Hospitals. 22 students have taken up PGY1 positions at Waikato Hospital and 2 at Rotorua. 2011 was notable for the first full cohort of 5th year students.

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Hauora Māori The School continues its partnership with Te Puna Oranga (Maori Health Unit) in the HRC funded project Oranga Tane Maori – Maori Men’s Health. This project is reviewing the impact of a whanau ora approach to Maori men’s health. The principal investigator is Mr. Wayne Johnstone and Prof. Ross Lawrenson, Dr Veronique Gibbons and Dr Jacqui Kidd are co-investigators.

Dr Rawiri Keenan is an Academic GP registrar with Midlands Health Network. Dr Keenan is undergoing postgraduate studies in General Practice and is involved in joint research between Midlands Health Network and the Waikato Clinical School.

Elective Students The WCS hosted 17 elective students in 2011. The WCS was unable to place 108 elective students from the UK and 64 from Germany.

WCS Prizes 2010

The David Clews Prize for Best Student at WCS Aaron Ooi For the student that best reflects the attributes of academic excellence, leadership and contribution to the community:

Waikato TI Prize in General Practice Stacey Hooper and sponsored by Midlands Health Network Amanda Van Zyl For the trainee intern that achieves the highest summation of individual marks awarded for performance during the general practice attachments:

Ellis Dick Trainee Intern Prize for Surgery James Wong For the most outstanding trainee intern in surgery:

Peter Rothwell Clinical Teacher Award Dr Kim McAnulty For recipients that show excellence in clinical training:

Rotorua Teachers Award Dr Tim Fletcher Ngongotaha Practice

Rotorua Trainee Intern Prize Aaron MacDonald

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Postgraduate Study There were 5 PhD and 5 MD students registered with The University of Auckland with supervisors from Waikato Clinical School during 2011. 2 students successfully defended their PhD thesis during this time - Dr Veronique Gibbons and Dr Steven Lillis. Dr Cat Chang and A/P Shailesh Kumar were awarded a Doctor of Medicine (MD).

Current PhD Students Mrs Deborah Harris (WCS supervisor Dr Phil Weston) Dr Nathaniel Chiang (WCS supervisor Prof Jamie Sleigh) Dr Ryan Paul (WCS supervisor Assoc Prof John Conaglen) Dr Zuzana Obertova (WCS supervisor Prof Ross Lawrenson)

MD In 2011 there were 5 Waikato Doctors enrolled for an MD with The University of Auckland Dr Gerard Devlin Dr Corrine Law Dr Sarina Lim Dr Jane Morgan Dr Paul Timmings

Masters Dr Jo Scott Jones (Senior Lecturer, Rural Health) was successful in his Masters of Medical Science (General Practice) which was conferred at the spring graduation ceremony.

Dr Rachel Thomson (Senior Lecturer, Rural Health) is completing a Masters in Rural General Practice about attitudes to the involvement of student doctors in their clinical care entitled “Do you mind seeing the student doctor?”.

Dr Andy Humphry (GP Liaison for Bay of Plenty DHB) completed his Masters in Health Sciences, looking at the content of referral letters from general practitioners. The thesis was entitled “Can’t Pee? Please See”.

Dr Wayne de Beer (Director of Clinical Training for Waikato DHB) was awarded a Masters in Medical Education which was conferred at the autumn graduation ceremony.

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Research The Waikato Clinical School is actively involved in medical research and publishes a number of papers every year. There are professorial units in Medicine, Anaesthetics, Psychiatry and General Practice. The establishment of these units was funded by the Waikato District Health Board.

All of our researchers work closely with their respective departments in the Faculty of Medical and Health Sciences in Auckland.

Medicine The research interests of the Department of Medicine at the Waikato Clinical School include Cardiology, Oncology, Endocrinology, Diabetes, Dermatology and Rheumatology. Key academic staff include; Associate Professor John Conaglen (Endocrinology and Sexual Dysfunction), Dr Win Meyer-Rochow (Endocrinological Surgery) and Dr Marianne Elston (Endocrinology), Associate Professor Peter Jones (Rheumatology), Dr Gerry Devlin, Dr Martin Stiles, Dr Mark Davis (Cardiology), Associate Professor Amanda Oakley and Associate Professor Marius Rademaker (Dermatology), Dr Nic Crook (Diabetes), and Dr Michael Jameson (Oncology). The department has strong links with AgResearch at Ruakura and has published a number of papers in conjunction with their researchers.

Cardiology Waikato Hospital is the tertiary cardiology referral centre for the midlands region. Dr Gerard Devlin is the clinical leader of the Midland Regional Cardiology Network. Dr Devlin is a local Principal Investigator in a number of large international clinical trials in acute coronary syndromes and heart failure. Dr Martin Stiles continues his postdoctoral studies in electrophysiology. Dr Mark Davis has taken the lead with his research on heart failure in conjunction with Dr Devlin and Dr Fisher.

Peer Reviewed Publications Perera S, Wijesinghe N, Ly E, Devlin G, Pasupati S. Outcomes of patients with untreated severe aortic stenosis in real-world practice. N Z Med J. 2011;124(1345):40-8.

Connolly MJ, Kenealy T, Barber PA, Carswell P, Clinton J, Dyall L, Devlin G, Doughty RN, Kerse N, Kolbe J, Lawrenson R, Moffitt A, Sheridan N. National variability in provision of health services for major long-term conditions in New Zealand (a report from the ABCC NZ study). N Z Med J. 2011;124(1344):16-35.

Sheridan NF, Kenealy TW, Connolly MJ, Mahony F, Barber PA, Boyd MA, Carswell P, Clinton J, Devlin G, Doughty R, Dyall L, Kerse N, Kolbe J, Lawrenson R, Moffitt A. Health equity in the New Zealand health care system: a national survey. Int J Equity Health. 2011;10(1):45.

Liang M, Kelly DJ, Devlin G Left main stem stenosis in the unstable patient-- forewarned is forearmed. N Z Med J. 2011;124(1338):111-3.

Aliprandi-Costa B, Ranasinghe I, Chow V, Kapila S, Juergens C, Devlin G,Elliott J, Lefkowitz J, Brieger DB Management and outcomes of patients with acute coronary

WCS Annual Report 2011 Page 5 of 19 syndromes in Australia and New Zealand, 2000-2007. Med J Aust. 2011;195(3):116- 21.

Liang M, Puri A, Devlin G The vulnerable plaque: the real villain in acute coronary syndromes. Open Cardiovasc Med J. 2011;5:123-9.

Liang M, Devlin G, Jogia D. Repeat transoesophageal echocardiogram is recommended in endocarditis patients with paravalvular oedema despite sensitivity to antibiotics and improving parameters. Ann Acad Med Singapore. 2011; 40(2):102- 2.

Liang M, Kelly D, Puri A, Devlin G. Mitral Stenosis as a Risk Factor for Embolic Myocardial Infarction-Anticoagulation for Some Patients, Individual Treatment for All. Heart Lung Circ. 2011;(11):728-30.

Devlin G, Reynolds HR, Mark DB, Rankin JM, Carvalho AC, Vozzi C, SopkoG, Caramori P, Džavík V, Ragosta M, Forman SA, Lamas GA, Hochman JS Loss of short-term symptomatic benefit in patients with an occluded infarctartery is unrelated to non-protocol revascularization: results from the Occluded Artery Trial (OAT) Am Heart J. 2011;161(1):84-90.

Tang AS, Wells GA, Talajic M, Arnold MO, Sheldon R, Connolly S, Hohnloser SH, Nichol G, Birnie DH, Sapp JL, Yee R, Healey JS, Rouleau JL; Resynchronization- Defibrillation for Ambulatory Heart Failure Trial Investigators. N Engl J Med. 2010;363(25):2385-95.

Endocrinology Associate Professor J V Conaglen heads the Department of Endocrinology at the Waikato Hospital and has active research links with Dr Marianne Elston, Endocrinologist and Dr Goswin Meyer-Rochow, Endocrine Surgeon. Together they have formed the Waikato Endocrine Research Unit.

Dr Conaglen is a leading researcher into sexual health and continues to conduct studies into the dyadic effects of sexual dysfunction. In collaboration with Drs Gerard Devlin, Chris McMahon and Sarina Lim, the Cardioendocrine Research Group has extended their repertoire of animal models by developing a murine model to further understand the role of myostatin in preventing loss of cardiomyocytes after myocardial infarction. Drs Conaglen, Elston and McMahon are supervising PhD student Dr Ryan Paul who is investigating the effects of growth hormone replacement on myostatin in growth hormone deficient patients.

Dr Meyer-Rochow was awarded his PhD in 2011 the subject of which was Molecular Genetic Markers in Phaeochromocytoma (University of Sydney) and has an active research interest in clinical and molecular aspects of phaeochromocytomas and paraganglioma. In addition to ongoing phaeochromocytoma research studies, the endocrine group are also actively researching thyroid disease.

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Peer Reviewed Publications Lim S, Elston MS, Gill AJ, Marsh DJ, Conaglen JV. Metastatic parathyroid carcinoma initially misdiagnosed as parathyroid adenoma: the role of parafibromin in increasing diagnostic accuracy. Int Med J. 2011;41:695-9.

Bolland MJ, Holdaway IM, Berkeley JE, Lim S, Dransfield WJ, Conaglen JV, Croxson MS, Gamble GD, Hunt PJ, Toomath RJ. Mortality and morbidity in Cushing’s syndrome in New Zealand. Clin Endocrinol. 2011;75:436-42.

Funding grants received Waikato Medical Research Foundation “Identification of somatostatin receptor subtypes in hereditary and sporadic phaeochromocytomas and paragangliomas” $6500

Waikato Medical Research Foundation “Assessment of Mitochondrial Morphology using Electron Microscopy for SDH Germline Mutation Associated Phaeochromocytomas” $6000

Awards Received Kudos Emerging Scientist award Dr Goswin Meyer-Rochow, Hamilton Science Awards, September 2011

Rheumatology The rheumatology research unit has continued its extensive involvement with ‘The Genetics of Gout in Aotearoa’ project, via the NZ Rheumatology Research Network and collaboration with geneticist Associate Professor Tony Merriman of Otago University. Dr Jones is a named investigator on an HRC programme grant 2011 continuation ‘The application of genetics to common chronic conditions’ ($4,765,885). He has research interests based at QE Health, Rotorua where there is an active clinical trials programme in rheumatoid arthritis, psoriatic arthritis and osteoporosis, as well as research into the outcomes of multidisciplinary rehabilitation. Research collaborations with Professor Fiona McQueen and Associate Professor Nicola Dalbeth in Auckland looked at the MRI features and pathophysiology of bone erosion in psoriatic arthritis, and with Associate Professors Lisa Stamp and Will Taylor of the University of Otago studied the allopurinol hypersensivity syndrome. The Waikato DHB clinical department is active in clinical trials in gout and rheumatoid arthritis.

McQueen F, Lloyd R, Doyle A, Robinson E, Lobo M, Exeter M, Taylor W, Jones PB, Reid IR and Dalbeth N. Zoledronic acid does not reduce MRI erosive progression in PsA but may suppress bone oedema: the zoledronic acid in psoriatic arthritis (ZAPA) study. Ann Rheum Dis. 2011;70:1091-1094

Phipps-Green A, McKinney C, Rossol M, Merriman ME, Topless R, Hollis-Moffat J, Wan Taib WR, Dalbeth N, Gow PJ, Harrison AA, Highton J, Jones PB, Stamp L, Wanger U, Wordsworth P and Merriman TR. Analysis of association of DNASE2 promoter variation with rheumatoid arthritis in European Caucasians. Ann Rheum Dis. 2011;70(8):1512-1514.

Hollis-Moffat, Gow PJ, Harrison AA, Highton J, Jones PB, Stamp LK, Dalbeth N and Merriman TR. The SLC2A9 non-synonymous Arg265His variant, rs3733591, and gout

WCS Annual Report 2011 Page 7 of 19 in New Zealand Māori, Pacific Island and Caucasian sample sets. Arthritis Res Ther. 2011;13(3):R85

Respiratory Respiratory Medicine continues to run an active research unit. Dr Karalus is one of the lead investigators in two HRC funded studies in bronchiectasis and tuberculosis in conjunction with the School of Medicine and the University of Waikato, whilst Professor Hancox (University of Otago) continues to provide invaluable support and guidance to overall research planning and analysis. Dr Cat Chang has returned to the Department after finishing her training in Sydney and was awarded her MD in July, 2011. The Waikato Respiratory Research Unit has current active research projects looking into the treatment of bronchiectasis, cystic fibrosis, obstructive airways disease and community acquired pneumonia. The Unit has been recognised nationally for its recent findings linking poor outcomes in pneumonia with vitamin D deficiency. More recently the Waikato Respiratory Research Unit has expanded into the area of sleep research, with involvement in the multi-national HRC and NHMRC funded Sleep Apnoea cardioVascular Endpoints (SAVE) study. The Unit continues to fund and supervise a doctoral research fellow.

Peer Reviewed Publications: Chang CL, Robinson SC, Mills GD, Sullivan GD, Karalus NC, McLachlan JD, Hancox RJ. Biochemical markers of cardiac dysfunction predict mortality in acute exacerbations of COPD. Thorax. 2011;66(9):764-8.

Lee MH, Hancox RJ. Effects of smoking cannabis on lung function. Expert Rev Respir Med. 2011;5(4):537-46

Chang CL, Sullivan GD, Karalus NC, Mills GD, McLachlan JD, Hancox RJ. Predicting Early Mortality in Acute Exacerbation of Chronic Obstructive Pulmonary Disease using CURB65 scores. Respirology. 2011;16:146-151

Leow L, Simpson T, Cursons R, Karalus N, Hancox RJ. Vitamin D, innate immunity and outcomes in community acquired pneumonia. Respirology. 2011;16(4):611-6.

Kelly PM, Kotsimbos T, Reynolds A, Wood-Baker R, Hancox RJ, Brown SG, Holmes M, Simpson G, Bowler S, Waterer G, Irving LB, Jenkins C, Thompson PJ, Cheng AC. FluCAN 2009: initial results from sentinel surveillance for adult influenza and pneumonia in eight Australian hospitals. Med J Aust. 2011;194(4):169-74

Bartlett D, Chang CL. Breaking the cycle of Insomnia. Med Today. 2011; 12(11):29-40

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Diabetes The Waikato Clinical school activities in the field of diabetes research have been curtailed following the resignation of Dr Grace Joshy who has moved to Australia and the return of the funding for her position to the Waikato Regional Diabetes service. The Clinical school have worked in collaboration with Dr Rawiri Keenan and Dr Janet Amey from the Midlands Health Network on the management of diabetes in primary care. Dr. Nic Crook continues his research activity in diabetes research from Rotorua.

Signal L, Firestone R, Mann J, Ni Mhurchu C, Lawrenson R, Murphy R, Schofield G, Sharpe N, Skeaff CM, Taylor R, Toomath R, Walton M. New Zealand's shocking diabetes rates can be reduced--9 urgently needed actions. N Z Med J. 2011;124(1340):89-92.

Oncology The Waikato Hospital is the second largest of six cancer centres in New Zealand and is actively involved in a number of clinical trials as well as initiating local research. The key researcher is Dr Michael Jameson who has been funded by the Waikato Bay of Plenty Division of the Cancer Society for his research time. Dr Marion Kuper- Hommel is the New Zealand chair of two large international phase 3 early breast cancer trials. She co-chairs one of these trials on behalf of the Australia-New Zealand Breast Cancer Trials Group (ANZBCTG). Dr Marion Kuper-Hommel continues her PhD studies through the Netherlands. Dr Leanne Tyrie is a co-investigator on the HRC funded study of the management of prostate cancer.

Jameson MB, Head M. Pharmacokinetic evaluation of vadimezan (ASA404, 5,6- dimethylxanthenone-4-acetic acid, DMXAA). Expert Opin Drug Metab Toxicol. 2011;7(10):1315-26

McKeage MJ, Gu Y, Wilson WR, Hill A, Amies K, Melink TJ, Jameson MB. A phase I trial of PR-104, a pre-prodrug of the bioreductive prodrug PR-104A, given weekly to solid tumour patients. BMC Cancer. 2011;11:432.

Rudman SM, Jameson MB, McKeage MJ, Savage P, Jodrell DI, Harries M, Acton G, Erlandsson F, Spicer JF. A phase 1 study of AS1409, a novel antibody-cytokine fusion protein, in patients with malignant melanoma or renal cell carcinoma. Clin Cancer Res. 2011;17(7):1998-2005.

Dermatology The Department of Dermatology at Waikato Hospital provides a leading role within New Zealand for both teaching and research. Staff include Associate Professor Marius Rademaker and Associate Professor Amanda Oakley. The department has a special interest in applying technology to dermatological education and teleconsultation. Senior medical staff members have presented at numerous international meetings and have published original research papers, case reports, reviews and critical appraisals for peer reviewed and general medical journals and textbooks. Amanda Oakley, with assistance from her colleagues in the department, has developed a comprehensive worldwide web site for the New Zealand Dermatological Society, NZ DermNet (www.dermnetnz.org). The site includes comprehensive information for patients about more than 1000 conditions and treatments and Continuing Medical Education for health professionals.

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Peer Reviewed Research Publications Lim D, Oakley AM, Rademaker M . Better, sooner, more convenient: a successful teledermoscopy service. Aust J Dermato. 2011;53(1), 22-5.

Hill SE, Yung A, Rademaker M. Prevalence of Staphylococcus aureus and antibiotic resistance in children with atopic dermatitis: a New Zealand experience. Aust J Dermato. 2011;52(1):27-31.

Duncan G, Stevens G, Boberg C, Harman R, Eccles M, Marshall B, Potter I, Rademaker M; MelNet Establishment Committee. Melanoma Summit highlights best practice and priorities for action. N Z Med J. 2011;124(1334),120-2.

Details of any awards won or honours received during 2011; Oakley A. Presidency of New Zealand Dermatological Society Incorporated Oakley A. Presidency of Australian and New Zealand Vulvovaginal Society

Breast Surgery The department remains active in clinical trials work on sentinel node biopsy, extended endocrine therapy, breast cancer prevention, and molecular markers to determine need for chemotherapy. Associate Professor Ian Campbell continues to publish and present data from the Waikato Breast Cancer Register and the RACS National Breast Cancer Audit. His department was successful in 2011 in attracting a Commonwealth funded PhD student from Sri Lanka to study outcomes in women with breast cancer. Quarterly Breast Cancer Research Reviews by Associate Professor Ian Campbell and Dr Richard Isaacs are also available on-line.

Paediatric Surgery Health Waikato have a very active Department of Paediatric Surgery which runs a tertiary regional service for the midland region with an extensive outreach service. The department has a special interest in Neonatal Surgery, Paediatric Urology and Minimal Access Surgery. They also have a particular interest in congenital abdominal wall defects and chest wall anomalies. Key researchers include Dr Askar Kukkady and Dr udaya Samarakkody.

Paediatrics Dr David Graham continues as the principal investigator of a randomised intervention study of exercise in school children funded by the Waikato DHB - Project Energize. Pedometer and fundamental movement skills projects were in collaboration with AUT. Dr Graham has been involved in investigator-initiated immunisation research as well as supervising a summer student through the University of Auckland Medical School to investigate bronchiolitis. The intervention arm is being run by Sport Waikato. Dr Anne Jaquiery, based in Rotorua and has a joint appointment with the Liggins Institute and the Waikato Clinical School. Her area of interest is foetal nutrition and its effects on subsequent development. Mrs Deborah Harris is a PhD student with the Liggins and is co-supervised by Dr Phil Weston.

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Anaesthetics The anaesthetic research group has interests into depth of anaesthesia monitoring and the detection of nociception while under general anaesthesia, and the modelling of anaesthesia, sleep, and seizures. The department is able to offer a broad-based clinical and neuroscience research environment for any prospective PhD and MD students. National and international collaborative links have been further strengthened with the publication of several co-authored papers, and involvement in a number of new multicentre clinical trials. The unit is led by Prof. Jamie Sleigh and supported by Dr John Barnard (Clinical Senior Lecturer), Dr Hugh Douglas (Clinical Senior Lecturer), and Dr Logan Voss (Research Fellow).

The department has external research collaboration links in 2011 with University of Waikato, University of Leiden, UC Berkeley, UC Stanford, Imperial College, University of Wisconsin (Madison), University of Otago, University of Adelaide, University of Melbourne, and Institute of Electrical Engineering, Yanshan University, Qinhuangdao, Hebei, China.

Peer-reviewed Publications Papers and Book Chapters Harvey M, Cave G, Chanwai G, Nicholson T. Successful resuscitation from bupivacaine-induced cardiovascular collapse with intravenous lipid emulsion following femoral nerve block in an emergency department. Emerg Med Australas. 2011;23(2):209-14

Harvey M, Cave G, Lahner D, Desmet J, Prince G, Hopgood G. Insulin versus Lipid Emulsion in a Rabbit Model of Severe Propranolol Toxicity: A Pilot Study. Crit Care Res Pract. 2011;2011:361737

Betham C, Harvey M, Cave G Manipulation of simple paediatric forearm fractures: a time-based comparison of emergency department sedation with theatre-based anaesthesia. N Z Med J. 2011;124(1344):46-53.

Harvey M, Cave G, Betham C..Contemporary sedation practice in a large New Zealand emergency department. N Z Med J. 2011;124(1344):36-45.

Cowell DL, Harvey M, Cave G.Antibiotic prophylaxis at triage for simple traumatic wounds: a pilot study. Eur J Emerg Med. 2011 Oct;18(5):279-81.

Voss LJ, George SA, Sleigh JW. Testing neocortical slice viability in non-perfused no- magnesium artificial cerebrospinal fluid solutions. J Neurosci Methods. 2011;204(2):273-275.

Van Haren FM, Sleigh J, Cursons R, La Pine M, Pickkers P, Van der Hoeven JG The effects of hypertonic fluid administration on the gene expression of inflammatory mediators in circulating leucocytes in patients with septic shock; a preliminary study. Ann Intensive Care. 2011;1(1):44.

Sleigh JW. Depth of Anesthesia: Perhaps the Patient Isn't a Submarine. Anesthesiology. 2011;115(6):1149-50

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Sleigh JW, Scheib CM, Sanders RD. General Anaesthesia and Electroencephalographic Spindles. Trends in Anaesthesia & Critical Care. 2011;(1):263-269.

Li D, Li X, Hagihira S, Sleigh JW. The effect of isoflurane anesthesia on the electroencephalogram assessed by harmonic wavelet bicoherence-based indices. J Neural Eng. 2011;(5):056011.

Jacobson GM, Voss LJ, Melin SM, Cursons RT, Sleigh JW. The role of connexin36 gap junctions in modulating the hypnotic effects of isoflurane and propofol in mice. Anaesthesia. 2011;66(5):361-7.

Pryor KO, Sleigh J. The Seven Bridges of Königsberg. Anesthesiology. 2011 ;114(4):739-40.

Steyn-Ross ML, Steyn-Ross DA, Sleigh JW, Wilson MT. A Mechanism for Ultra-Slow Oscillations in the Cortical Default Network. Bull Math Biol. 2011;73(2):398-416

Lopour BA, Tasoglu S, Kirsch HE, Sleigh JW, Szeri AJ. A continuous mapping of sleep states through association of EEG with a mesoscale cortical model. J Comput Neurosci. 2011;30(2):471-87.

Books/Chapters J.W. Sleigh, L. Voss, M.L. Steyn-Ross, D.A. Steyn-Ross, and M.T. Wilson. Modelling Sleep and General Anaesthesia. In Sleep and Anesthesia: Neural Correlates in Theory and Experiment. Axel Hutt (ed). Springer Series in Computational Neuroscience. 2011;(15) ISBN 978-1-4614-0172-8 pp21-45.

D.A. Steyn-Ross, M.L. Steyn-Ross, J.W. Sleigh, and M.T. Wilson. Progress in Modeling EEG Effects of General Anesthesia: Biphasic Response and Hysteresis. In Sleep and Anesthesia: Neural Correlates in Theory and Exerpiment. Axel Hutt (ed). Springer Series in Computational Neuroscience. 2011;(15) ISBN 978-1-4614-0172-8 pp167-195.

Voss LJ, Jacobson GM, Sleigh JW. Bridging the gap - understanding the role of gap junctions in seizures. In: Epilepsy / Book 6, Underlying Mechanisms of Epilepsy. Edited by F Kaneez. InTech. 2011;ISBN 978-953-307-765-9.

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Psychiatry 2011 marked another happy and productive year for Waikato Clinical School Psychiatry. Congratulations are due to Shailesh Kumar and Wayne de Beer on their own, higher degree, successes. David Menkes extended his work in drug treatments, pharmaceutical policy, and physical health in psychiatric patients. Graham Mellsop continued to work and publish in the general fields of classification, Maori mental health and outcomes, in collaboration with a number of co-workers.

During 2012 Graham Mellsop received the Annual Citation of the Royal Australian New Zealand College of Psychiatrists, for life long contributions to Australasian and International Psychiatry. Kahu McClintock continued publishing reports derived from her awarded PhD.

Peer Reviewed Publications Duggal R, Menkes DB. Evidence-based medicine in practice. Int J Clin Pract. 2011;65:639–644.

Menkes DB. New Zealand doctors and the pharmaceutical industry—time to cut the cord? N Z Med J. 2011;124:6-8.

Mellsop GW, Fraser D, Tapsell R, Menkes DB. Courts’ Misplaced Confidence in Psychiatric Diagnoses. Int J Law Psychiatry. 2011;34:331-335.

Menkes DB, Shieffelbien L, Huthwaite M. Hypnosedative access and risk of harm. N Z Med J. 2011;124:69-73.

Ziganshina LE, Menkes DB, Herxheimer A. Quality information for quality use of medicines. Int J Risk Saf Med. 2011;23:187-92.

Herxheimer A, Menkes DB. Drinking alcohol during antidepressant treatment — a cause for concern? Pharm J. 2011;287:732-733 .

Menkes DB. Transient psychotic relapse temporally related to ingestion of an ‘energy drink’. Med J Aust. 2011;194:206.

Menkes DB, Kidd J, Southey K, Orr M, Fitzgerald J, Christini-Crawford D. Online access to personal health information: a pilot study in severe mental illness. N Z Med J. 2011;124:1334-4675

Menkes DB. Conflicts of interest and drug information. BMJ. 2011;343:d5617.

Mellsop GW, Lutchman R, Lillis S, Dutu G The Views of Psychiatrists, General Practitioners, Psychologists and Consumers on Aspects of Present and Preferred Classification Systems. Eur Psychiatry. 2011;26:61-63.

Mellsop GW, Tapsell R. Culturally Correlated Characteristics of Mental Health Service Users in New Zealand. Eur Psychiatry. 2011;26:30-33

Mellsop, GW, Fraser D, Tapsell R., Menkes DM. Rethinking Categorical Classification in Psychiatry. Int J Law Psychiatry. 2011;34:331-335

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El Badri, S, Mellsop, GW. Clozapine use and outcomes among patients with treatment resistant schizophrenia. Aust Psychiatry.2011;19(5):410-4

McClintock K, Mellsop, GW, Kingi Te Kani R. Development of a culturally attuned psychiatric outcome measure for an indigenous population. Int J Cult Ment Health 2011;4:128-143

Mellsop GW, Diesfeld K. Legal frameworks for compulsory treatment. Shanghai Archives of Psychiatry, 2011;23:73-74

International Advisory Group for the revision of ICD-10 Mental and Behavioural Disorders (16 co-authors) A conceptual framework for the revision of the ICD-10 Classification of Mental and Behavioural Disorders. World Psychiatry, 2011; 10:86- 93 (G. Mellsop is a member of the IGC).

Mellsop GW. China’s new approaches to an old problem. Shanghai Archives of Psychiatry. 2011;23:243-244

Mellsop GW. Diesfeld K. Psychiatric Diagnoses in Legal Systems. Int J Med Law 2011

Mellsop G, Leon-Andrade C, Chiu HFK, Shinfuku N, Chan WC (2011) Asian/Pacific Rim psychiatrists’ views on aspects of future classifications. Asia-Pacific Psychiatry 3: 228-234. ISSN 1758-5864 DOI:10.1111/j1758-5872.2011.00158.x

McClintock K, Moeke-Maxwell T, Mellsop GW. Appropriate Child and Adolescent Mental Health Service (CAMHS): Maori Caregiver’s Perspectives. Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health 2011; 9(2) 387-398 Other Publications Menkes DB. Commentary. Psychiatry Research Review 25:1-4 (2011). Menkes DB. Commentary. Psychiatry Research Review 26:1-4 (2011). Menkes DB. Commentary. Psychiatry Research Review 27:1-4 (2011). Menkes DB. Commentary. Psychiatry Research Review 28:1-4 (2011). Menkes DB. Commentary. Psychiatry Research Review 29:1-4 (2011). Menkes DB. Commentary. Psychiatry Research Review 30:1-4 (2011).

Books/Chapters Mellsop GW, Clapham-Howard F. Utilising Psychiatric Diagnosis and Formulation in the Clinical Process: Meeting the Needs and Expectations of Service Users. In, Psychology, text book of Clinical Psychology, Open Access Publication by Intech. (http//www.intechweb.org/books), 2011;ISBN 979-953-307-637-8

Kumar S, Mellsop GW. Gender Aspects, In Burnout for Experts: Prevention in the context of living and working, Ed S Baehrer-Kohler, Springer, New York 2011

De Beer W, Eds. Coll RK, Zegwaard KE. International Handbook for Cooperative and Work-Integrated Education: International Perspectives of Theory, Research and Practice (Second Edition) Waikato Print, University of Waikato. 2011. Successful Grants

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2010-2012, Waikato District Health Board Mental Health Research Trust, “Cardiovascular Risk in New Zealanders treated with antipsychotic drugs”, DB Menkes, $29,000 over 24 months.

2011, Zenith Technology and Douglas Pharmaceuticals, DB Menkes was principal investigator for the Clozapine Bioequivalence Study (Waikato arm). Administered by Uniservices, $163,300 over six months

General Practice and Rural Health The department has had a busy year. Research continues with interests extending to Diabetes, Health Literacy, Palliative Care, Prostate Cancer, Heart Failure, Thyroid Disease, and Maori Health (chronic disease and cancer). Research has been conducted by Professor Ross Lawrenson, Dr Fraser Hodgson (Senior Lecturer in General Practice) and Dr Veronique Gibbons (Research Fellow in Primary Care). Much of this research has been in conjunction with local General Practitioners. Dr Fraser Hodgson continues to study towards a Masters in Medical Science investigating GP views of prostate cancer. Dr Rachel Thomson completed her Masters qualification supported through the Waikato Clinical School. Veronique Gibbons completed her doctoral thesis on “The Epidemiology and Management of Hypothyroidism in General Practice”. Former Senior Lecturer in General Practice Dr Steven Lillis completed his PhD. The department continues to work in collaboration with Waikato DHB on HRC funded projects (Oranga Tane Maori with Te Puna Oranga (Maori Health Service) and ‘Can an integrated heart failure service improve diagnosis and management of heart failure? led by Dr Anita Bell (Public Health) and Dr Mark Davis (Cardiology). The department was also successful with the HRC grant for $900,000 looking at prostate cancer.

Lawrenson RA, Nixon G, Steed RH. The rural hospital doctors workforce in New Zealand. Rural Remote Health. 2011;(2):1588.

Lillis S, Lord H.Repeat prescribing--reducing errors. J Prim Health Care. 2011;3(2):153-8.

Ghuman M, Rohlandt D, Joshy G, Lawrenson R. Post-caesarean section surgical site infection: rate and risk factors. N Z Med J. 2011;124(1339):32-6.

Sheridan NF, Kenealy TW, Connolly MJ, Mahony F, Barber PA, Boyd MA, Carswell P, Clinton J, Devlin G, Doughty R, Dyall L, Kerse N, Kolbe J, Lawrenson R, Moffitt A. Health equity in the New Zealand health care system: a national survey. Int J Equity Health. 2011;20;10(1):45.

Kara E, Gibbons V, Kidd J, Blundell R, Johnstone W. Developing a Kaupapa Maori Framework for Whanau Ora. Alternative: An International Journal of Indigenous Peoples. 2011;7(2):100-110.

Fullerton M, Gibbons V. Needlestick injuries in a healthcare setting in New Zealand. N Z Med J. 2011;27;124(1335):33-9.

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Sexual Health Research Unit The Sexual Health Research Unit facilitates education and research in the field of sexual dysfunction in New Zealand by promoting an increased understanding and awareness of sexual function and dysfunction for health and allied professionals and the general public.

The Unit is a multidisciplinary team with expertise in medicine, endocrinology, clinical psychology, sexual health, and research methodology, and links with public health and education. It focuses on clinical research in couples’ sexual health, function and dysfunction, sexuality and psycho-oncology issues. SHRU also sees the training and education of clinicians and researchers in the field of sexual health, function and dysfunction as a core role.

During the second year of its existence the SHRU multidisciplinary team is working on sexual function following treatment for prostate cancer as part of the Midlands Prostate Cancer Study. We are also investigating the impact on Couples of a Man’s Localised Prostate or Colon Carcinoma Treatment, and also the impact of brachytherapy on sexual function.

Brachytherapy Studies: [i] Psychosocial characteristics and quality of life of men with intermediate or high risk prostate cancer undergoing high dose rate brachytherapy with or without androgen deprivation therapy. A manuscript based on this work was submitted during March 2012. [ii] The Impact of High Dose-rate Brachytherapy on men’s quality of life and sexual function beyond 2 years. The unit is also supervising Ms Angela Rennie, who is currently completing a Masters study of women and vulvodynia researching the impact of the treatment options available to them.

Peer Reviewed Publications McCabe, MP, O'Connor, EJ, Conaglen, JV, Conaglen, HM. The Impact of Oral ED Medication on Female Partners' Relationship Satisfaction. J Sex Med. 2011;8(2): 479-483.

Conaglen HM, Conaglen JV, O'Connor E, McCabe MP. Attitudes and experiences: Qualitative perspectives on erectile dysfunction from the female partner. J Health Psychol. 2011;17(1):3-13.

Thomas, P., Tuck, W., Shennan, J., Conaglen, H.M., Bell, J., (2011). An investigation into the health benefits of Mindfulness-Based Stress Reduction (MBSR) for a specific range of chronic illnesses. Technical Report.

Conaglen, HM, & Conaglen, JV. (2011, June). Erectile Dysfunction Update. Pharmacy Today.

WCS Annual Report 2011 Page 16 of 19

Successful Grants Conaglen, HM. (2011) Investigating the Impact on Couples of a Man’s Prostate or Colon Carcinoma Treatment: A Pilot Study. Waikato Medical Research Foundation Grant. $18,000.

Public Health and Sexual Health Dr Anita Bell continues to work with Dr Richard Wall a Public Health Medicine Registrar. Dr Jane Morgan, consultant in public health has also joined the Clinical School as an Honorary Senior Lecturer in Sexual Health. Jane has a particular interest in the epidemiology and management of chlamydia and has begun work on her MD Thesis on The Epidemiology and Management of Chlamydia.

Peer Reviewed Publications Wall R, Dymond N, Bell A, Thornley C, Buik H, Cumming D, Petersen N. Two New Zealand outbreaks of norovirus gastroenteritis linked to commercially farmed oysters. N Z Med J. 2011;124(1347):63-71.

Wall R, Bell A, Theobald J. Pertussis (whooping cough) epidemiology in Waikato, New Zealand: 2000-2009. N Z Med J. 2011;124(1332):52-61.

Morgan J, Colonne C, Bell A. Trends of reported chlamydia infections and related complications in New Zealand, 1998-2008. Sex Health. 2011;8(3):412-8.

Nursing 2011 was marked by the appointment of Dr. Matthew Parsons as Professor of Geriatric Nursing to the Waikato DHB. Dr Jacquie Kidd and Kathy Shaw are involved in the teaching and Masters supervision of a significant number of nurses from Waikato DHB and the Midlands region. Research in 2011 included the final stages of an exploration into the experiences of whanau ora for Maori men who have chronic illness or cancer, and an evaluation of ‘healthy living programmes’ in forensic inpatient settings.

Kara E, Gibbons V, KiddJ., Blundell R, Turner K, & Johnstone W. Developing A Kaupapa Māori Framework For Whānau Ora. Alternative. 2011;7(2):100-110.

Prebble K, Kidd J, O'Brien A, Carlyle D, McKenna B, Crowe M, Deering D, Gooder C. 'Implementing And Maintaining Nurse-Led Healthy Living programs in forensic inpatient settings: An illustrative case study', J Am Psychiatr Nurses Assoc. 2011;17(2):127-138.

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Summer Students

The Waikato Clinical School offers ‘Summer Studentships’ each year. This program is managed by Assoc Prof John V Conaglen. In 2011 we awarded 14 summer studentships which were mostly funded by the Waikato DHB.

Student Supervisor Project Title Name

Is surgery the best first-line definitive John Conaglen Kelson Tu'akoi therapy for patients with Grave's Disease?

Effect of single dose Dexamethasone on the Cameron Marianne Elston hypothalamic-pituitary axis Hughes

Does a clinical guideline change Chlamydia Jane Morgan case management? Lydia Mills

Claire Vitamin D status in community-acquired Leong Leow Mulholland pneumonia

Assessment of cardiac function in a NZ Dom Vettise Catherina Chang community-acquired pneumonia cohort James Peter Kirk Why do palliative care patients attend ED? Waetford

EEG patterns, responsiveness & pain during Jono MacColl Jamie Sleigh recovery from general anaesthesia Investigating the similarities between the lining of the respiratory tract & the middle Linda Peters inner ear in order to understand the Sarah Moratti pathways for microbe infection Investigation into viability & gene expression Nadine Ray Cursons of umbilical vein endothelial cells in an ex Huitema vivo whole cord model Michael Holmes The current use of, effectiveness & accuracy Danni Zhang of 3 Tezla MRI of the prostate The impact of high dose-rate brachytherapy Dennis de Leanne Tyrie on men's quality of life & sexual function Jong beyond 2 years Denise Aitken Multiple readmission in patients with heart Stella Li failure Alexandra Deconstructing Historical Thought Peter Rothwell Horsley

Creation of a NZ prostate cancer risk Michael Holmes calculator based on pre-biopsy Harry Jones characteristics

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Waikato Clinical Skills and Simulation Centre The Centre had another busy and successful year with courses and workshops for a wide range of health professionals. The Centre is managed by Mr Rob Sinclair with support from Kevin Nation and Renee McKeany.

Highlights for the year include: • June Trainee Intern CORE Resuscitation and Procedural Skills weeks • Midland Health Network Practical Skills weekend workshops for Practice Nurses covering suturing, IV therapy, wound care and ECG understanding • Two three-day APLS (Paediatric Life Support) courses and two three-day EMST (Trauma) courses for registrars from around New Zealand • Grassroots (rural medical and nursing students) practical skills weekend • Nine Newborn Life Support courses for midwives • Purchase and extensive use of our new SimMan 3G wireless human patient simulator – some in-situ in the new Emergency Dept and assisting paramedic training in the back of an ambulance • Over 200 resuscitation education courses for many different groups • Continuing education sessions for GPs and Practice nurses • Regular simulation sessions for ICU, ED, CCU, PACU, Ward 14, Anaesthetics and Wintec

WCS Administration Current WCS meetings/committees include; - WCS Executive meetings – 6 weekly - WCS Faculty meeting – a meeting of all clinical staff 4 times a year

Administration Staff - School Manager - Administrative Assistant/Secretary to Head of School - Administrative Assistant/Secretary to Professor of Psychiatry - Student Administrator

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