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THE NEW ZEALAND MEDICAL JOURNAL Journal of the New Zealand Medical Association CONTENTS This Issue in the Journal 3 A summary of the original articles featured in this issue Editorials 6 Will brief interventions in primary care change the heavy drinking culture in New Zealand? J Douglas Sellman, Jennie L Connor, Geoffrey M Robinson 10 Are two internal thoracic artery grafts as safe as one? David Taggart 12 Avoidable complications following chest tube insertion David Shaw, Frank A Frizelle 15 Submitting articles to the New Zealand Medical Journal via Manuscript Manager Frank A Frizelle Original Articles 17 Is routine alcohol screening and brief intervention feasible in a New Zealand primary care environment? Heather Gifford, Sue Paton, Lynley Cvitanovic, John McMenamin, Chloe Newton 26 Chest tube drainage of pleural effusions—an audit of current practice and complications at Hutt Hospital Erica Epstein, Sisira Jayathissa, Stephen Dee 36 Are two internal thoracic artery grafts as safe as one? Experience from Green Lane Hospital Arul Baradi, Paget F Milsom, Alan F Merry 42 An evaluation of a pictorial asthma medication plan for Pacific children John Kristiansen, Edlyn Hetutu, Moana Manukia, Timothy Jelleyman 51 Unusually virulent coagulase-negative Staphylococcus lugdunensis is frequently associated with infective endocarditis: a Waikato series of patients Michael Liang, Chris Mansell, Clyde Wade, Raewyn Fisher, Gerard Devlin NZMJ 11 May 2012, Vol 125 No 1354; ISSN 1175 8716 Page 1 of 123 http://journal.nzma.org.nz/journal/125-1354/5167/ ©NZMA 60 Did an acute medical assessment unit improve the initial assessment and treatment of community acquired pneumonia: a retrospective audit David G Tripp 68 Old Man’s Friend? Resuscitation decisions in patients hospitalised with pneumonia David G Tripp 75 Implementing and sustaining a hand hygiene culture change programme at Auckland District Health Board Sally A Roberts, Christine Sieczkowski, Taima Campbell, Greg Balla, Andrew Keenan; on behalf of the Auckland District Health Board Hand Hygiene Steering and Working Groups Viewpoint 86 The further and future evolution of the New Zealand Immunisation Schedule Stewart Reid Clinical Correspondence 100 Mondor’s disease in a patient previously treated for breast carcinoma in situ: a case report Brenda Leal, Sabas Vieira, Bárbara Carvalho, Airthon Correia, Benedito Almeida 103 Medical image. Half-and-half nail Anirban Das, Sabyasachi Choudhury, Sudipta Pandit, Sibes K Das Letters 105 Breast thermography review—and author response Michael E Godfrey 110 Survey of hot water temperatures in campgrounds: elevated scalding risk and energy wastage Nick Wilson, Jonathan Jarman, Bill Brander, Michael Keall 100 Years Ago in the NZMJ 114 A case of X-ray dermatitis Methuselah 115 Selected excerpts from Methuselah Obituaries 117 Hon Sir Peter Wilfred Tapsell 120 Jeremiah Alfred Chunn 122 Andrew Richmond (Tangi) Martin NZMJ 11 May 2012, Vol 125 No 1354; ISSN 1175 8716 Page 2 of 123 http://journal.nzma.org.nz/journal/125-1354/5167/ ©NZMA THE NEW ZEALAND MEDICAL JOURNAL Journal of the New Zealand Medical Association This Issue in the Journal Is routine alcohol screening and brief intervention feasible in a New Zealand primary care environment? Heather Gifford, Sue Paton, Lynley Cvitanovic, John McMenamin, Chloe Newton This paper reports on a demonstration project that tested the feasibility of alcohol screening and a brief intervention approach, consisting of advice and referrals, in general practice in a New Zealand region. The results suggest that good uptake of the intervention is possible and the paper concludes with a number of reasons why the intervention was successful in one primary care setting. The authors conclude that if the approach was more widely adopted, there is considerable scope for general practice nationally to address potentially harmful patient alcohol use. Chest tube drainage of pleural effusions—an audit of current practice and complications at Hutt Hospital Erica Epstein, Sisira Jayathissa, Stephen Dee Chest drains are inserted for removal of fluid and air accumulated within chest cavity outside the lung and it is commonly performed by junior medical staff. We looked at our practice of chest drain insertions for fluid and found our complication rate to be similar to described elsewhere. Good training for junior staff, inserting chest drains with bed side ultrasound will improve safety from this procedure. Are two internal thoracic artery grafts as safe as one? Experience from Green Lane Hospital Arul Baradi, Paget F Milsom, Alan F Merry In coronary artery surgery, it is thought that using bilateral internal thoracic artery grafts confer a long-term survival advantage for patients when compared to unilateral internal thoracic artery grafts. However, due to concern regarding perceived short- term risks associated with bilateral internal thoracic artery grafting, the majority of patients do not receive bilateral grafts. We conducted a retrospective study of 6592 patients undergoing coronary artery surgery at Green Lane / Auckland Hospitals between 1990 and 2004. After correcting for patient risk factors, we found no difference in the rate of perioperative complications between patients receiving surgery with either bilateral or unilateral internal thoracic artery grafts. This suggests that more patients can safely be offered bilateral internal thoracic artery grafting. An evaluation of a pictorial asthma medication plan for Pacific children John Kristiansen, Edlyn Hetutu, Moana Manukia, Timothy Jelleyman NZMJ 11 May 2012, Vol 125 No 1354; ISSN 1175 8716 Page 3 of 123 http://journal.nzma.org.nz/journal/125-1354/5183/ ©NZMA Pacific children are over-represented in hospital admissions for asthma; education may improve outcomes. We developed www.pamp.co.nz for health professionals to use with Pacific families; it produces personalised asthma education materials in three Pacific languages with a pictorial format. A study of 48 families showed they were well used, and improved medicines knowledge and symptom recognition. Our approach may help other ethnicities. This is the first study about asthma education resources in Pacific children. Unusually virulent coagulase-negative Staphylococcus lugdunensis is frequently associated with infective endocarditis: a Waikato series of patients Michael Liang, Chris Mansell, Clyde Wade, Raewyn Fisher, Gerard Devlin Staphylococcus lugdunensis is frequently associated with infective endocarditis and it is as aggressive as Staphylococcus aureus endocarditis. Stayphylococcus lugdunensis can be mistaken as less virulent coagulase-negative Staphylococcus . Assessment for endocarditis should be considered if S . lugdunensis bacteraemia is present, i.e. echocardiography is recommended. Investigation for suspected endocarditis should include at least three sets of blood cultures, to distinguish contamination or transient bacteraemia from the continuous bacteraemia of endocarditis. Did an acute medical assessment unit improve the initial assessment and treatment of community acquired pneumonia: a retrospective audit David G Tripp The Medical Assessment and Planning Unit at Wellington Hospital was opened in November 2009. It aimed to be a “one-stop-shop” for people needing acute medical assessment referred from GPs, and also people presenting to the Wellington Emergency Department (ED) who needed further review. This study reviewed patients presenting with pneumonia before and after this change to see how the new system was working in this group of patients. The new system seems to be working well, in that weller patients are going to the MAPU, and avoiding time in the ED first. Some opportunities to improve the timeliness of the new processes, and to be more comprehensive in our assessment, were identified, and are now the subject of ongoing development work. Old Man’s Friend? Resuscitation decisions in patients hospitalised with pneumonia David G Tripp When someone is admitted to hospital that is at risk of dying, it is worthwhile to discuss with the patient and their family how they would like to be cared for should their condition deteriorate. These discussions often include whether they would like cardiopulmonary resuscitation (CPR) in hospital should their heart stop. Increasingly, however, there is a move to make these discussions broader—talking with elderly people about what they do and do not want done for them in their last years. This study reviewed 155 patients admitted to hospital with pneumonia. This was once NZMJ 11 May 2012, Vol 125 No 1354; ISSN 1175 8716 Page 4 of 123 http://journal.nzma.org.nz/journal/125-1354/5183/ ©NZMA called “the old man’s friend”—pneumonia was a common cause of death in the frail or elderly, and a relatively quick and painless way to die. However, many other people with pneumonia are well and make a full recovery. This study aimed to see if it was possible to differentiate between those at high and low risk of dying, and then see if those at high risk of dying were included in discussions about end-of-life care. The study found that simple criteria could highlight those at greatest risk. In particular, half of those over 80 had died within one year—some while in hospital, but most in the months after they returned home. Despite this, few had documented discussions about the care they would like at the end of their lives. This represents a missed opportunity. Such admissions have the potential to be a good opportunity to have difficult but important conversations about
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