WAIKATO CLINICAL SCHOOL

FACULTY OF MEDICAL AND HEALTH SCIENCES

ANNUAL REPORT 2013

Waikato Clinical School Annual Report 2013

Assistant Dean 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

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 School supports the School of Nursing’s post-graduate programme and a number of university-led projects that are based in Waikato.

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 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 recognise the considerable support we receive from the Waikato District Health Board. We also have strong links with Lakes and the Bay of Plenty DHBs and Midlands Health Network.

Over the years the School has received funding from the Waikato Medical Research Foundation and appreciate its ongoing support of research.

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 first cohort of 24 final year medical students commenced in November 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 their strategic partnership with the Waikato DHB and formally signed a ‘Strategic Alliance Agreement’ in November 2005.

NB: In 2014 the name Waikato Clinical School was changed to Waikato Clinical Campus.

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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 the 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. In 2013 we had our first full 4th year cohort. These students were under the invigorated curriculum including general medicine, specialty medicine and geriatrics as well as surgery and a week of general practice. We took a cohort of 20 students and shared the general medicine teaching with Rotorua. Our Midland 5th Year cohort consisted of 48 students in 2013 with clinical attachments in Waikato, Rotorua and Tauranga Hospitals. We also had 29 Trainee Interns at Waikato. Of these, 18 Waikato DHB students have taken up PGY1 positions at Waikato Hospital. This was the 3rd year that Waikato Clinical School have taken a full cohort of 5th year medical students.

Hauora Māori The School continues its partnership with Te Puna Oranga (Māori Health Unit). The HRC-funded project on prostate cancer came to its final stage at the end of the year. Dr Nina Scott has been our Māori academic advisor on the project. Part of this study has been looking at the cause of the inequity in outcomes for Māori patients with prostate cancer and a separate report is planned on this in 2014. (We have also had the support of Mr Rawiri Blundell with Midland Cancer Network Maori Advisory Group).

The final report for the Health literary in Palliative Care for Māori (PI Dr Jacquie Kidd) was also approved by the HRC.

Dr Sanjeewa Seneviratne continues his research on differential outcomes for Māori woman with breast cancer.

Elective Students The WCS hosted 19 elective students in 2013. The WCS declined 176 elective students. Many of our elective applications are from the UK and Germany.

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WCS Prizes 2013

The David Clews Prize for Best Student at Waikato Clinical School For the student that best reflects the attributes of academic excellence, leadership and contribution to the community: Martin Mikaere

Waikato TI Prize in General Practice sponsored by Midlands Health Network For the trainee intern that achieves the highest summation of individual marks awarded for performance during the general practice attachments: Martin Mikaere

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

Peter Rothwell Clinical Teacher Award For recipients that show excellence in clinical training: Dr Chris Lynch and Dr Paul Timmings

Te Pae Tata o Te Hauora Hinengaro - Trainee Intern Prize for Excellence in Psychiatry Phillip Chao

Postgraduate Study There were 8 PhD scholars, 5 MD students and 2 masters students registered with The University of Auckland with supervisors from Waikato Clinical School during 2013.

Current PhD Students Dr Nathaniel Chiang (supervised Prof Jamie Sleigh) Chunhuan Lao (supervised by Prof Ross Lawrenson) Zuzana Obertova (supervised by Prof Ross Lawrenson) Dr Sanjeewa Seneviratne (supervised by Prof Lawrenson & A.Prof Ian Campbell) Dr Ryan Paul (supervised by A. Prof John Conaglen) Dr Jade Tamatea (supervised by A.Prof John Conaglen) Alice Wang (supervised by Prof Lynn Ferguson) Darren Hight (supervised Prof Jamie Sleigh)

MD Dr Sangeeta Dey (supervised by Prof Graham Mellsop) Dr Corrine Law (supervised by Prof Jamie Sleigh) Dr Sarina Lim (supervised by A.Prof John Conaglen) Dr Paul Timmings (supervised by Prof Jamie Sleigh)

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Dr Grant Cave (supervised by Prof Jamie Sleigh)

Masters Dr Poornima Nair (supervised by Prof Ross Lawrenson) Claire O’Shea (supervised by Prof Ross Lawrenson)

Research There are four professorial units within the Waikato Clinical School: Medicine, Anaesthetics, Psychiatry and Primary Care. The establishment of these units was initially 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, Respiratory, Oncology, Endocrinology, Dermatology and Rheumatology. Key academic staff involved with research include: Associate Professor John Conaglen (Endocrinology and Sexual Dysfunction) Dr Marianne Elston (Endocrinology), and Dr Win Meyer-Rochow (Endocrine Surgery); 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 Michael Jameson (Oncology) and Dr Cat Chang (Respiratory). The department has strong links with AgResearch at Ruakura and has published a number of papers in collaboration with their researchers.

Cardiology Dr Gerry Devlin is a Cardiologist and Associate Professor in Medicine with the Waikato Clinical School, University of Auckland. He leads the Clinical Unit of cardiac services at Waikato Hospital and is the Clinical Leader of the Midland Cardiac Network. Martin Stiles is a Cardiologist and Senior Lecturer specialising in electrophysiology.

Publications 1. ST-Elevation Myocardial Infarction Guidelines Group; New Zealand Branch of Cardiac Society of Australia and New Zealand. N Z Med J. 2013 Dec 13;126(1387):127-64. 2. Kerr AJ, Lin A, Lee M, Ternouth I, Killion B, Devlin G; Risk stratification and timing of coronary angiography in acute coronary syndromes: are we targeting the right patients in a timely manner? (ANZACS-QI 1).N Z Med J. 2013 Dec 13;126(1387):69-80. 3. Ellis C, Gamble G, Devlin G, Elliott J, Hamer A, Williams M, Matsis P, Troughton R, Ranasinghe I, French J, Brieger D, Chew D, White H. The

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management of acute coronary syndrome patients across New Zealand in 2012: results of a third comprehensive nationwide audit and observations of current interventional care. New Zealand Acute Coronary Syndromes (NZACS) SNAPSHOT Audit Group; N Z Med J. 2013 Dec 13;126(1387):36- 68. 4. Ten Y, Devlin G. Bivalirudin in acute coronary syndromes and percutaneous coronary intervention: should we use it? Heart Lung Circ. 2013 Oct;22(10):793-800. 5. Overgaard CB, Džavík V, Buller CE, Liu L, Banasiak W, Devlin G, Maggioni AP, Leor J, Burton JR, Reis G, Ruzyllo W, Forman SA, Lamas GA, Hochman JS Percutaneous revascularization and long term clinical outcomes of diabetic patients randomized in the Occluded Artery Trial (OAT). OAT Investigators. Int J Cardiol. 2013 Oct 3;168(3):2416-22. 6. Santhanakrishnan R, Ng TP, Cameron VA, Gamble GD, Ling LH, Sim D, Leong GK, Yeo PS, Ong HY, Jaufeerally F, Wong RC, Chai P, Low AF, Lund M, Devlin G, Troughton R, Richards AM, Doughty RN, Lam CS.The Singapore Heart Failure Outcomes and Phenotypes (SHOP) study and Prospective Evaluation of Outcome in Patients with Heart Failure with Preserved Left Ventricular Ejection Fraction (PEOPLE) study: rationale and design. J Card Fail. 2013 Mar;19(3):156-62.

Endocrinology Dr Marianne Elston, Dr Goswin Meyer-Rochow, Endocrine Surgeon along with Associate Professor J V Conaglen from the Waikato Endocrine Research Unit, continue to investigate thyroid disorders particularly thyrotoxicosis. They have developed strong collaborative links with Dr Stephen Ng in the ophthalmology department to study a novel approach to the management of moderately severe Graves’ opthalmopathy. Dr Jade Tamatea has commenced her PhD working on the impact of ethnicity on patients with thyrotoxicosis. Dr Helen Conaglen continues to work as a senior research fellow with the group in addition to developing collaborative links with the dermatology department.

Dr Sarina Lim in the the Cardioendocrine Research Group has submitted her thesis for an MD investigating a murine model to further understand the role of myostatin in preventing loss of cardiomyocytes after myocardial infarction. Drs Conaglen, Elston and McMahon continue to supervise PhD student Dr Ryan Paul who is investigating the effects of growth hormone replacement on myostatin in growth hormone deficient patients. Dr Meyer-Rochow continues with an active research interest in clinical and molecular aspects of phaeochromocytomas and paraganglioma.

Dr Jane Morgan in the Sexual Health Unit won the prestigious 2013 Kudos Prize for Medical Research

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Publications 1. Elston MS, Conaglen HM, Hughes C, Tamatea JA, Meyer-Rochow GY, Conaglen JV. Duration of cortisol suppression following a single dose of dexamethasone in healthy volunteers: a randomised double-blind placebo- controlled trial. Anaesth Intensive Care. 2013 Sep;41(5):596-601. 2. Elston MS, Meyer-Rochow GY, Prosser D, Love DR, Conaglen JV. Novel mutation in the TMEM127 gene associated with phaeochromocytoma. Intern Med J. 2013 Apr;43(4):449-51. 3. Elston MS, Meyer-Rochow GY, Prosser D, Love DR, Conaglen JV. Novel mutation in the TMEM127 gene associated with phaeochromocytoma. Intern Med J. 2013 Apr;43(4):449-51.

Rheumatology Associate Professor Peter Jones left the WCS at the end of 2013 ot take up a position in the Ministry of Health as a Senior Medical Advisor. Dr Douglas White has been appointed as Senior Lecturer in rheumatology (Rheumatologist with the Waikato Hospital Rheumatology Unit). The department continues to recruit for the ‘The Genetics of Gout in Aotearoa’ project (HRC Programme grant) and data from this have been presented at international conferences and resulted in a number of publications. The focus has been on the interaction of genetic with environmental factors. In addition, the unit contributes to the Spondyloarthritis Genetics and the Environment (SAGE) study which is a national longitudinal study of patients with ankylosing spondylitis. This study has generated it's first paper on the prevalence of HLA-B27 in New Zealand.

The Unit has been active in clinical research, enrolling patients in studies of a new uricosuric agent for gout, and in studies of new biologic drugs for rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis and psoriatic arthritis.

Hamilton was the venue for the 2013 New Zealand Rheumatology Association annual conference which was organised by the Rheumatology Unit at Waikato Hospital. We welcomed guest speakers from the USA and Australia who presented on systemic lupus erythematosus, systemic sclerosis, pregnancy in rheumatic disease and bone pathology. In addition, local researchers had an opportunity to present oral abstracts and posters.

Publications 1. Plunkett M, Lamont D, Brooker J, White D. Relapsing polychondritis: response to tocilizumab and association with colitis. J Clin Rheumatol. 2013 Oct;19(7):415-7. 2. White D, Pahau H, Duggan E, Paul S, Thomas R. Trajectory of intensive treat-to-target disease modifying drug regimen in an observational study of an early rheumatoid arthritis cohort. BMJOpen, 013 Jul 31;3(7).

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3. Rasheed H, Phipps-Green A, Topless R, Hollis-Moffatt JE, Hindmarsh JH, Franklin C, Dalbeth N, Jones PB, White DH, Stamp LK, Merriman TR. Association of the lipoprotein receptor-related protein 2 gene with gout and non-additive interaction with alcohol consumption. Arthritis Res Ther. 2013 Nov 4;15(6):R177. 4. Roberts RL, Wallace MC, Jones GT, van Rij AM, Merriman TR, Harrison A, White D, Stamp LK, Ching D, Highton J, Stebbings SM. Prevalence of HLA-B27 in the New Zealand population: effect of age and ethnicity. Arthritis Res Ther. 2013 Oct 22;15(5):R158.

Respiratory Respiratory Medicine continues to run an active research unit. Dr Noel 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 Associate Professor Bob Hancox (University of Otago) continues to provide invaluable support and guidance to overall research planning and analysis. In addition, Dr Cat Chang returned to the Department after finishing her training in Sydney and being awarded a MD in July, 2011, and continues with her research interests. 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 with recent publications in each of these subjects. The Unit continues to fund and supervise a doctoral research fellow.

Oncology Dr Michael Jameson, Honorary Senior Clinical Lecturer, and Dr Marion Kuper work within The Regional Cancer Centre at Waikato Hospital, which spans medical and radiation oncology, haematology and palliative care, with staff actively involved with service development both at a local and national level. A key focus for the service, in addition to quality of patient care, is research and staff education/development. Dr Kuper has contributed to the work of the breast cancer research group and the Midland Prostate study. She was awarded her PhD from the Radboud University Nijmegen, Netherlands in 2013.

Publications 1. Kuper-Hommel MJ, van de Schans SA, Vreugdenhil G, van Krieken JH, Coebergh JW. Trends in incidence, therapy and outcome of localized nodal and extranodal marginal zone lymphomas: declining incidence and inferior outcome for gastrointestinal sites. Leuk Lymphoma. 2013 Sep;54(9):1891-7. 2. Goss PE, Smith IE, O'Shaughnessy J, Ejlertsen B, Kaufmann M, Boyle F, Buzdar AU, Fumoleau P, Gradishar W, Martin M, Moy B, Piccart-Gebhart M, Pritchard KI, Lindquist D, Chavarri-Guerra Y, Aktan G, Rappold E, Williams LS, Finkelstein DM; TEACH investigators.Adjuvant lapatinib for women

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with early-stage HER2-positive breast cancer: a randomised, controlled, phase 3 trial. Lancet Oncol. 2013 Jan;14(1):88-96. 3. Kuper-Hommel MJ, van de Schans SA, Vreugdenhil G, van Krieken JH, Coebergh JW. Undertreatment of patients with localized extranodal compared with nodal diffuse large B-cell lymphoma. Leuk Lymphoma. 2013 Aug;54(8):1698-705. 4. Kuper-Hommel MJ, Schreuder MI, Gemmink AH, van Krieken JH T(14;18)(q32;q21) involving MALT1 and IGH genes occurs in extranodal diffuse large B-cell lymphomas of the breast and testis. Mod Pathol. 2013 Mar;26(3):421-7.

Dermatology The Department of Dermatology at Waikato Hospital provides a leading role within New Zealand for both teaching and research. The Department has a strong academic focus, and is particularly noted for its research and publications on medical dermatology, teledermatology and teledermoscopy. Staff includes Hon. Associate Professor Marius Rademaker and Hon 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 DermNet NZ (www.dermnetnz.org). The site includes comprehensive information for patients about more than 1000 conditions and treatments and Continuing Medical Education for health professionals.

Professor Oakley and Dr Rademaker have been made International Honorary Members of the American Dermatological Association (Oakley) and Mexican Academy of Dermatology (Rademaker). Dr Oakley was further awarded an Honorary Membership of the American Academy of Dermatology, and Dr Rademaker a member of Sigma Si, the Scientific Research Society. Dr Oakley has been invited to be a Member of the International Advisory Board for the Department of Dermatology at Balaji Medical College, Chennai, India.

Publications 1. Lim D, Rademaker M, Asztely F, Ratnaweera M, Coltman G. Cerebral vasculitis and multi-focal neurological deficits due to allopurinol-induced hypersensitivity syndrome. Australas J Dermatol. 2013 Jan 18. 2. Lim D, Rademaker M, Asztely F, Ratnaweera M, Coltman G. Cerebral vasculitis and multi-focal neurological deficits due to allopurinol-induced hypersensitivity syndrome. Australas J Dermatol. 2013 Jan 18. 3. Lin CY, Oakley A, Rademaker M, Hill S, Yung A. Effect of narrowband ultraviolet B phototherapy on melanocytic naevi. Br J Dermatol. 2013

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Apr;168(4):815-9. 4. Rademaker M, Wishart JM, Birchall NM. Isotretinoin 5 mg daily for low- grade adult acne vulgaris - a placebo-controlled, randomized double-blind study. J Eur Acad Dermatol Venereol. 2013 Apr 26. 5. Rademaker M. Face-masks for facial atopic eczema: consider a hydrocolloid dressing. Australas J Dermatol. 2013 Aug;54(3):222-4. 6. Rademaker M. Isotretinoin: dose, duration and relapse. What does 30 years of usage tell us? Australas J Dermatol. 2013 Aug;54(3):157-62. 7. Rademaker M, Wishart JM, Birchall NM. Isotretinoin 5 mg daily for low- grade adult acne vulgaris - a placebo-controlled, randomized double-blind study. J Eur Acad Dermatol Venereol. 2013 Apr 26. 8. Australas J Dermatol. 2013 Aug;54(3):222-4. Surgery The Department of Surgery have a number of academic appointments including A/P Ian Campbell, Mr Win Meyer-Rowhow and Mr Thodor Vaseudavan. In addition Mr Askar Kukkady and Mrs Udaya Samarakkody lead an active paediatric surgical department while Mr Adam el Gamel is the Clinical Director of the Cardiothoracic Surgical Unit. Mr Grant Christey heads the Midland Trauma Registry Research Group and leads trauma research to the region. In 2013 in conjunction with Dr Bridget Kool the group were awarded $160,000 from the Auckland Medical Research Foundation. Research themes for the Department include breast surgery, endocrine surgery (see Department of Medicine) vascular/cardiothoracic surgery, trauma and paediatric surgery.

Breast Surgery Associate Prof Ian Campbell continues to publish and present data from the Waikato Breast Cancer Register and National Breast Cancer Audit. Dr Sanjeewa Seneviratne, a PhD scholar from Sri Lanka, is presently undertaking a research project to investigate reasons for poor outcomes among Maori women with breast cancer in the Waikato region supervised by Assoc Prof Ian Campbell and Prof. Ross Lawrenson. This three year project is expected to analyse data from approximately 3000 women with breast cancer diagnosed in the Waikato over a period of 20 years.

Publications 1. Roder D, Zorbas H, Kollias J, Pyke C, Walters D, Campbell I, Taylor C, Webster F Risk factors for poorer breast cancer outcomes in residents of remote areas of Australia. Asian Pac J Cancer Prev. 2013;14(1):547-52. 2. Roder D, Zorbas H, Kollias J, Pyke C, Walters D, Campbell I, Taylor C, Webster F.Factors predictive of treatment by Australian breast surgeons of invasive female breast cancer by mastectomy rather than breast conserving surgery. Asian Pac J Cancer Prev. 2013;14(1):539-45. 3. Roder D, Zorbas H, Kollias J, Pyke C, Walters D, Campbell I, Taylor C, Webster F.Factors predictive of immediate breast reconstruction following

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mastectomy for invasive breast cancer in Australia.Breast. 2013 Dec;22(6):1220-5. 4. Chong C, Walters D, de Silva P, Taylor C, Spillane A, Kollias J, Pyke C, Campbell I, Maddern G. Initial axillary surgery: results from the BreastSurgANZ Quality Audit. ANZ J Surg. 2013 Nov 20. 5. Chong C, Walters D, de Silva P, Taylor C, Spillane A, Kollias J, Pyke C, Campbell I, Maddern G. Subsequent axillary surgery after sentinel lymph node biopsy: results from the BreastSurgANZ Quality Audit 2006-2010. Breast. 2013 Dec;22(6):1215-9.

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. The department accepts regular students from the University of Auckland; additionally it is open to selective and elective students from New Zealand and overseas. There is an extensive teaching program and a research program available to such students.

Cardiothoracic Surgery Mr Adam el Gamel is leading research in the area of cardiothoracic surgery in conjunction with Vascular Surgeon Mr Thodur Vasudevan.

Publications 1. Barbanti M, Ye J, Pasupati S, El-Gamel A, Webb JG. The Helio transcatheter aortic dock for patients with aortic regurgitation. EuroIntervention. 2013 Sep 10;9 Suppl:S91-4.

Paediatrics Paediatric Medicine at Waikato forms part of a spectrum of services under the Waikids umbrella which includes Mothercraft, Child Development Centre, Children's Clinic, Mental Health services, Emergency Department, Child Protection Service, Oral Health, and inpatients. Dr David Graham has been the principal investigator in a randomised intervention study of exercise in school children funded by the Waikato DHB - Project Energize. The intervention arm is being run by Sport Waikato.

Mrs Deborah Harris finalised her PhD with the Liggins Institute co-supervised by Dr Phil Weston. David Graham has been an Honorary Clinical Senior Lecturer in the Department of Paediatrics: Child and Youth Health for 20 years. He became the first 2012 Dennis Pickup Award recipient from the School of Medicine. He has led the undergraduate teaching programme for paediatric trainee interns at the Waikato District Health Board and contributes actively to Paediatric 5th year teaching and postgraduate teaching.

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Publications 1. Harris DL, Weston PJ, Signal M, Chase JG, Harding JE. Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): a randomised, double- blind, placebo-controlled trial. Lancet. 2013 Dec 21;382(9910):2077-83.

Anaesthetics The academic Department of Anaesthesia is led by Prof. Jamie Sleigh and supported by Dr Logan Voss (Research Scientist), Dr John Barnard (Clinical Senior Lecturer/Clinical Anaesthetist), Dr Hugh Douglas (Clinical Senior Lecturer/Clinical Anaesthetist). Dr Kelly Byrne has been very active in promoting clinical research within the department. Dr Martyn Harvey from the Emergency Department is also working closely with Professor Sleigh in a collaboration with Professor Denny, on the development of ester analogues of ketamine. The anaesthetic research group has interests in: depth-of-anaesthesia monitoring and the detection of nociception while under general anaesthesia, and the modelling of anaesthesia, sleep, and seizures.

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. Current external organisation which the Department has research collaborations with include: Waikato University, University of Leiden, UC Berkeley, UC Stanford, University of Wisconsin (Madison), University of Adelaide, University of Melbourne, Institute of Electrical Engineering, Yanshan University, , ,

Publications 1. Elbohouty M, Wilson MT, Voss LJ, Steyn-Ross DA, Hunt LA. In vitro electrical conductivity of seizing and non-seizing mouse brain slices at 10 kHz. Phys Med Biol. 2013 Jun 7;58(11):3599-613. 2. Voss LJ, Baas CH, Hansson L, Li D, Sleigh JW. Investigation into the effect of the general anaesthetic etomidate on local neuronal synchrony in the mouse neocortical slice. Brain Res. 2013 Aug 14;1526:65-70. 3. Sleigh J. The place of the isolated forearm technique in modern anaesthesia: yet to be defined. Anaesthesia. 2013 Jul;68(7):681-3. 4. Harvey M, Cave G. Octreotide may attenuate absorption and ameliorate toxicity following enteric drug overdose. Med Hypotheses. 2013 Sep;81(3):424-5. 5. Law CJ, Jacobson GM, Kluger M, Chaddock M, Scott M, Sleigh JW. Randomized controlled trial of the effect of depth of anaesthesia on postoperative pain. Br J Anaesth. 2013 Dec 8.

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Mulholland CV, Somogyi AA, Barratt DT, Coller JK, Hutchinson MR, Jacobson GM, Cursons RT, Sleigh JW. .Association of Innate Immune Single-Nucleotide Polymorphisms with the Electroencephalogram During Desflurane General Anaesthesia. J Mol Neurosci. 2013 Dec 19. [ 6. Voss LJ, van Kan C, Sleigh JW. Quantitative investigation into methods for evaluating neocortical slice viability. BMC Neurosci. 2013 Nov 6;14(1):137 7. Selvaraj P, Sleigh JW, Freeman WJ, Kirsch HE, Szeri AJ. Open loop optogenetic control of simulated cortical epileptiform activity. J Comput Neurosci. 2013 Oct 31. 8. Kennedy R, McKellow M, French R, Sleigh J. Sevoflurane end-tidal to effect-site equilibration in women determined by response to laryngeal mask airway insertion. Anesth Analg. 2013 Oct;117(4):786-91. 9. Jose J, Gamage SA, Harvey MG, Voss LJ, Sleigh JW, Denny WA. Structure- activity relationships for ketamine esters as short-acting anaesthetics. Bioorg Med Chem. 2013 Sep 1;21(17):5098-106 10. Sleigh JW. The study of consciousness comes of age. Anesthesiology. 2013 Jun;118(6):1245-6 11. Shalbaf R, Behnam H, Sleigh JW, Steyn-Ross A, Voss LJ. Monitoring the depth of anesthesia using entropy features and an artificial neural network. J Neurosci Methods. 2013 Apr 6;218(1):17-24 12. Liang Z, Wang Y, Ouyang G, Voss LJ, Sleigh JW, Li X. Permutation auto- mutual information of electroencephalogram in anesthesia. J Neural Eng. 2013 Feb 1;10(2):026004. 13. Li D, Voss LJ, Sleigh JW, Li X. Effects of Volatile Anesthetic Agents on Cerebral Cortical Synchronization in Sheep. Anesthesiology. 2013 Jul;119(1):81-8. 14. Li D, Liang Z, Wang Y, Hagihira S, Sleigh JW, Li X. Parameter selection in permutation entropy for an electroencephalographic measure of isoflurane anesthetic drug effect. J Clin Monit Comput. 2013 Apr;27(2):113-23. 15. Li D, Li X, Hagihira S, Sleigh JW. Cross-frequency coupling during isoflurane anaesthesia as revealed by electroencephalographic harmonic wavelet bicoherence. Br J Anaesth. 2013 Mar;110(3):409-19. 16. Steyn-Ross ML, Steyn-Ross DA, Sleigh JW. Gap junctions modulate seizures in a mean-field model of general anesthesia for the cortex. Cogn Neurodyn. 2013 Jun;6(3):215-25. 17. Kelly Byrne and Conrad Engelbrecht, Toxicity of local anaesthetic agents, Trends in Anaesthesia and Critical Care Volume 3, Issue 1, Pages 25-30 , February 2013

Ongoing Research Studies: 1) Characterisation of EEG patterns during emergence from general anesthesia 2) Ketamine-ester analogue development. 3) Contribution of patient recruitment to the ATACUS, and BALANCED studies

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4) The genetics of anaesthetic awareness. 5) Tramadol as escape analgesia

Research Grants / Funding 1) 2013. The James S. McDonnell Foundation. Probing the overlap between sleep and anesthesia to enhance human cognition. With Paul Garcia (Emory University, Atlanta) and Divya Chander (Standford University) $1,250,000.

Psychiatry The department of Psychiatry continues to be research active. Data collection in the observational research projects being conducted by Drs Sangeeta Dey and Elnike Brand continued under the supervision of Professor Mellsop with significant supervision contributions from Associate Professor David Menkes and Dr Zuzanna Obertova. David continued his analysis and writing up of several projects, including metabolic syndrome and substance use co-morbidity surveys.

Publications 1. Gaebel W, Mellsop G et al. Stigmitization of Psychiatrists and General Practitioners: Results of an International Survey. Clinical Psychiatry 2013 2. McClintock K, Roimata Tauroa, Graham Mellsop, Christ Frampton Pilot of Te Tomo Mai, A Child and Adolescent Mental Health Service Evaluation Tool for an Indigenous Rangatahi (Youth) Population. Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health 2013; 11:1 3. Phillips M, Chen H, Diesfeld K, Xie B, Cheng H, Mellsop G, Liu X. China’s New Mental Health Law: Reframing Involuntary Treatment. The American Journal of Psychiatry, 2013;170:6 588-591 4. Svensson S, Menkes DB, Lexchin J. Surrogate endpoints in clinical trials: a cautionary tale. JAMA Intern Med. 2013;173(8):611-612

General Practice and Rural Health Research within the department has a number of strands including Mental Health, Diabetes, Heart Failure, Thyroid Disease, Maori Health (chronic disease and cancer) and Medical Education. Research has been conducted by Professor Ross Lawrenson, and Dr Veronique Gibbons (Research Fellow). Much of this research has been in conjunction with local General Practitioners including Dr Fraser Hodgson and Dr Rawiri Keenan.

One area of research has been the Midland Prostate Cancer Study which was completed in 2013 with a final report to the HRC. This project has been very ably managed by Dr Charis Brown and currently has 3 PhD students. Additional research in the department includes a study of foot care in people with diabetes led by Claire O’Shea and a study of the use of patient web portals in patients with diabetes by Dr Poornima Nair.

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Publications 1. Lao C, Brown C, Obertová Z, Edlin R, Rouse P, Hodgson F, Holmes M, Gilling P, Lawrenson R. The costs of identifying undiagnosed prostate cancer in asymptomatic men in New Zealand general practice. Fam Pract. 2013 Dec;30(6):641-7. 2. Lawrenson R, Waetford J, Gibbons V, Kirk P, Haggar S, Reddy R. Palliative care patients' use of emergency departments. N Z Med J. 2013 Apr 5;126(1372):80-8. 3. Keenan R, Amey J, Lawrenson R. The impact of patient and practice characteristics on retention in the diabetes annual review programme. J Prim Health Care. 2013 Jun 1;5(2):99-104

Public Health Dr Anita Bell, Public Health Physician at Waikato and Dr Richard Wall, a Public Health Medicine Registrar in Auckland, have collaborated on research into heart failure diagnosis and treatment at Waikato Hospital.

Publications 1. Cowie G, Bell A. A retrospective review of notified human cryptosporidiosis cases in the Waikato region of New Zealand, 2004 to 2011. N Z Med J. 2013 Sep 27;126(1383):29-37 2. Mills G, Bell A. Meningococcal disease in New Zealand. N Z Med J. 2013 Apr 19;126(1373):10-1. No abstract available.

Nursing Dr Jacquie Kidd, Mrs Kathy Shaw and Ms Grace Williams are involved in the postgraduate teaching and Masters Supervision of over 120 nurses from the Waikato DHB and the Midlands region. Jacquie’s research focus this year is on housing and accommodation for vulnerable populations including mental health service users. She is principal investigator on an Oakley Foundation funded study ‘Changing Expectations: analysing the landscape of housing support in the New Zealand mental health sector’ and is also involved in a Transforming Cities study ‘Housing needs of vulnerable populations’.

Kathy is co-investigating a study on the ‘Evaluation of postgraduate education for graduate nurses and experienced nurses’ in Waikato. Jacquie and Kathy both supervise small numbers of Masters students and provide academic mentorship for nurses planning their postgraduate study.

Publications 1. Kidd, J.D; Gibbons, V; Kara, E; Blundell, R; Berryman, K. 'A whanau ora journey of Maori men with chronic illness: A Te Korowai analysis', AlterNative: an international journal of indigenous scholarship, 2013; 9,

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(2): p125-141. 2. Kidd, J.D; Bulter, K; Harris, R. 'Maori mental health', In: Procter, N; McGarry, D; Froggatt, T; Hamer, H; Wilson, R. (ed.) Mental Health Nursing: A person centred approach, Port Melbourne, Victoria, Australia, Cambridge University Press, 2013p72-88.

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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 2013 we awarded 14 summer studentships which were mostly funded by the Waikato DHB.

Student Supervisor Project Title Name

Tramadol vs Morphine for refractory pain in the recovery Dr Kelly Byrne room Megan Tozer

Integrating Ticagrelor into the Management of Acute A/P Gerard Devlin Coronary Syndromes: The Midland Cardiac Network Charles Heald Experience

Dr E Shafuddin & Cardiac dysfunction in chronic obstructive pulmonary Dr Catherina Chang disease (COPD) Manisha Cooray

Dr Logan Voss & General anaesthetic modulation of memory-related Laura Bell Dr Linda Peters gene expression in neocortical brain slices Dr Michael Jameson, Selenium as a modulator of toxicity of chemotherapy Dr Steve Bird, Dr Linda and radiation on peripheral blood haematopoietic stem Stephen Evans Peters, Dr Ray Cursons cells

Dr Linda Peters & In Vitro effects of selenium on DNA damage in BRCA1 Dr Michael Jameson cell lines Kirsty Mayall

Dr Grant Christey Midland Paediatric trauma study Shobna Singh

Evaluation of the influence of ethinicity on the Mania Campbell- Dr Jade Tamatea Hyperthyroid Symptom Scale score in euthyroid and Seymour thryotoxic patients

Clinical Utility of Cognitive Screening Tools (CUtCoST) Dr Etuini Ma'u in New Zealand Sam Harris

The use of Not for Resuscitation (NFR) orders on an Dr Colin Patrick acute psychogeriatric inpatient unit Julia Berney

A review of referrals made to Waikato DHB Mental Health Service for Older People for clients presenting Dr Juliette Troy & with Behavioural and Psychological Symptoms of Dr PSDV Prasadarao Dementia: an analysis of current service provision and David Hoskins identification of potential service improvements Severe Sepsis in a District of New Zealand: Dr Paul Huggan Epidemiology, Outcomes and Possible Association with James Waetford Ethnicity and Socioeconomic Deprivation Post Radical Prostectomy Radiotherapy in the salvage Dr Michael Holmes and adjuvant setting. Indications, outcomes and Alex Carr predictive variables for biochemical cure A comparative review of the outcomes of standard type Anshuman Gupta Mr Adam El Gamel A acute aortic dissections in the Waikato

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Waikato Clinical Skills and Simulation Centre Waikato Clinical Skills and Simulation Centre 2013 saw another busy and successful year with an increasing number of courses and workshops for a wide range of health professionals.

Highlights for the year include: o Three Trainee Intern CORE Resuscitation and Procedural Skills weeks o Conference and a three-day workshop for fifty Vascular Surgeon Trainees from Australia and NZ o Two three-day APLS (Paediatric Life Support) courses and two three-day EMST (Trauma) courses for registrars from around New Zealand o Grassroots (rural medical and nursing students) practical skills weekend, and an interest day for Year 13 students from rural secondary Campuses with an interest in pursuing a career in health o Nine Newborn Life Support courses for midwives o Purchase and extensive use of our new SimMan 3G wireless human patient simulator – some in-situ in the new Emergency Dept, ICU and Cath Lab o Over 200 NZRC CORE resuscitation courses for many different groups o Continuing education sessions for GPs and Practice nurses o Regular simulation sessions for ICU, ED, CCU, PACU, Ward 14, Anaesthetics and Wintec o Extensive use of our new Studiocode video and debriefing software o Allocation of additional rooms to the Skills centre from early 2014 to allow concurrent sessions and break out space

Rob Sinclair, Director of the Skills Centre, would once again like to acknowledge and thank all the teaching staff for their excellent contributions and enthusiasm in helping to make the centre an on-going success and a valuable resource for all our health professionals - with special mention to Kevin Nation and Renee McKeany for their continued interest, innovation and extra commitment to the centre.

WCS Administration Current WCS meetings/committees include; WCS Staff meetings monthly WCS Executive meetings 6 weekly WCS Teachers meetings 4 times a year - all clinical staff

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Administration Staff School Manager Personal Assistant to Assistant Dean of School Student Administrator/Secretary Student Administrator/Secretary

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