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Chowdary P, Hastie R, Lino T, Middleton A, Capes G, Humphries A, Abed-Ali A, Anderson M, Mol BWJ, Horne A, Lim E, Andrew P, Brownfoot F, Tong S. Oral vinorelbine to treat women with ectopic pregnancy: a phase 1 clinical safety and tolerability study. Fertil Steril 2023; 120:695-696. [PMID: 37245616 DOI: 10.1016/j.fertnstert.2023.05.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 05/13/2023] [Accepted: 05/22/2023] [Indexed: 05/30/2023]
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Whittaker R, Andrew P, Dobson R, Bramley D. Innovation in Aotearoa New Zealand's healthcare system-how to make it happen. THE NEW ZEALAND MEDICAL JOURNAL 2022; 135:79-89. [PMID: 35834836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
To date innovation in Aotearoa New Zealand healthcare services has varied around the country. As we move into a health system restructure, it is important to reflect on what has worked to date and how we can take these elements into the new system. In this paper we describe the approach at Waitematā District Health Board (DHB) including the establishment of an Institute for Innovation and Improvement. We highlight what we view as the key elements of an innovation enabling environment and suggest measures of success.
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Dobson R, Baty C, Best G, Wells S, Wang K, Hallett K, Andrew P, Whittaker R. Digital solutions for providing patients access to hospital-held health information: what are the design issues that need to be addressed? THE NEW ZEALAND MEDICAL JOURNAL 2022; 135:114-123. [PMID: 35728254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A patient and whānau centred healthcare system includes patients having easy access to their health records when and where they need it. Accessible digital solutions providing patients with access to their health information, including hospital-held healthcare records, will support patients and whānau to be active and informed participants in their health. A Northern Region proof-of-concept, providing patients with electronic access to their hospital-held health information, identified several challenges in the design of such "portals". The purpose of this paper is to present a discussion of these challenges, and to present a review of the literature on how other countries and health settings have managed them. The review has led to recommendations around how delegated access, auditing access, adding and correcting of information, the timing of test result availability, and retrospective records should be handled. However, more investigation is required into the challenges surrounding how various types of more sensitive information should be handled. There is still considerable work to be done on how to technically and operationally transform these "default design principles" into reality within the complexity of New Zealand hospitals' electronic health information systems.
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Mukhin E, Nelyubov V, Yukish V, Smirnova E, Solovei V, Kalinina N, Nagaitsev V, Valishin M, Belozerova A, Enin S, Borisov A, Deryabina N, Khripunov V, Portnov D, Babinov N, Dokhtarenko D, Khodunov I, Klimov V, Razdobarin A, Alexandrov S, Elets D, Bazhenov A, Bukreev I, Chernakov A, Dmitriev A, Ibragimova Y, Koval A, Kurskiev G, Litvinov A, Nikolaenko K, Samsonov D, Senichenkov V, Smirnov R, Tolstyakov S, Tereschenko I, Varshavchik L, Zhiltsov N, Mokeev A, Chernakov P, Andrew P, Kempenaars M. Radiation tolerance testing of piezoelectric motors for ITER (first results). FUSION ENGINEERING AND DESIGN 2022. [DOI: 10.1016/j.fusengdes.2022.113017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Dobson R, Whittaker R, Wihongi H, Andrew P, Armstrong D, Bartholomew K, Sporle A, Wells S. Patient perspectives on the use of health information. THE NEW ZEALAND MEDICAL JOURNAL 2021; 134:48-62. [PMID: 35728109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
AIM This survey aimed to investigate patient perspectives, including preferences, needs and concerns, on the use of, and access to, individual healthcare information. METHOD A mixed-methods cross-sectional survey of adult patients (n=1,377) in Waitematā District Health Board inpatient and outpatient services during November-December 2020. The survey was online and on paper and available in 10 languages. RESULTS Over 80% of participants were comfortable with their health information being used across the scenarios presented (range: 81-89%). Māori were significantly more likely than non-Māori to be comfortable with their health information being combined with the health information of others to better understand population needs (p=0.006). The level of comfort with the use of individual health information was related to assurances that its use was for public good, data were stored securely, individual privacy was maintained, the information was accurate and there was communication on how it was used. DISCUSSION This study has shown that most healthcare consumers are comfortable with the health service using their de-identified health information beyond their care if it benefits others.
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Buslakov I, Kirienko I, Modestov V, Loginov I, Senichenkov V, Mukhin E, Litvinov A, Babinov N, Tolstyakov S, Chernakov P, Marinin G, Terentiev D, Bulkin R, Pashkovsky S, Mokeev A, Tanaka S, Andrew P, Nagy D. Structural analysis of the diagnostic rack locking in ITER lower port #8. FUSION ENGINEERING AND DESIGN 2021. [DOI: 10.1016/j.fusengdes.2021.112903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Modestov V, Kirienko I, Buslakov I, Loginov I, Shagniev O, Lavrova V, Senichenkov V, Mukhin E, Litvinov A, Samsonov D, Tolstyakov S, Babinov N, Chernakov P, Marinin G, Terentiev D, Bulkin R, Pashkovsky S, Mokeev A, Tanaka S, Andrew P. Structural analysis of large-scale SS collecting mirrors for ITER diagnostics. FUSION ENGINEERING AND DESIGN 2021. [DOI: 10.1016/j.fusengdes.2021.112634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Whittaker R, Dobson R, Hopley L, Armstrong D, Corning-Davis B, Andrew P. Training clinicians to lead clinical IT projects. THE NEW ZEALAND MEDICAL JOURNAL 2020; 133:116-122. [PMID: 33332334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Across New Zealand, a huge programme of work is being initiated to improve the health information systems of our sector. The goals of this plan are to address major risks and issues such as cybersecurity and our inability to securely share health data across organisations for clinical care. To fulfil the promise of planned health IT initiatives, we must involve clinicians of all disciplines to help lead, design and implement projects. However, there is currently little pragmatic training available for clinicians to learn how to do so. In 2019, Waitematā District Health Board and the National Institute for Health Innovation developed and delivered a 'hands-on' Clinical Digital Academy training programme for multidisciplinary clinicians. This paper describes the programme, the initial cohort's evaluation feedback and recommendations for the future.
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Millar JS, Lawes CM, Farrington B, Andrew P, Misur P, Merriman E, Walker M. Incidence of venous thromboembolism after total hip, total knee and hip fracture surgery at Waitemata District Health Board following a peer-reviewed audit. THE NEW ZEALAND MEDICAL JOURNAL 2020; 133:52-60. [PMID: 32161421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIM The incidence of venous thromboembolism (VTE) following arthroplasty and hip fracture surgery remains an important metric for quality and financial reasons. An audit at our institution between 2006-2010 showed a higher VTE rate than international data did at the time. This study aims to determine rates of DVT and PE in patients undergoing hip and knee arthroplasty and hip fracture surgery at Waitemata District Health Board (Waitemata DHB) between 1 January 2013 and 31 December 2016. METHODS This study is a retrospective review of all VTE within three months of elective hip or knee replacement or hip fracture surgery. Data were identified for the period between 2013 and 2016 from Waitemata DHB patient databases, including a dedicated VTE database. RESULTS The current rates of deep vein thrombosis (DVT) and pulmonary embolism (PE) at our institution following hip or knee arthroplasty or hip fracture surgery are 1.5% and 0.6% respectively, a lower rate than 2.3% and 0.9% respectively in 2006-2010. DVTs were significantly more prevalent after hip fracture surgery than after elective hip or knee arthroplasty, and 71% of DVTs were confined to the distal veins. Of the patients undergoing surgery, 93% received post-operative chemoprophylaxis, mainly aspirin or low molecular-weight heparin (LMWH). CONCLUSION There has been a significant reduction in VTE rates following elective hip and knee joint replacement and hip fracture surgery between the time periods. This occurred over a period when Waitemata DHB introduced a multi-modal, interdisciplinary team approach to VTE prophylaxis utilising enhanced recovery after surgery (ERAS) pathways. These measures may therefore have contributed to the reduction in VTEs.
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Gorbunov A, Mukhin E, Berik E, Melkumov M, Babinov N, Kurskiev G, Tolstyakov S, Vukolov K, Lisitsa V, Levashova M, Andrew P, Kempenaars M, Vayakis G, Walsh M. Laser-induced fluorescence of helium ions in ITER divertor. FUSION ENGINEERING AND DESIGN 2019. [DOI: 10.1016/j.fusengdes.2019.04.091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kornev A, Davtian A, Kovyarov A, Makarov A, Oborotov D, Pokrovskii V, Porozov A, Sobolev S, Stupnikov V, Kurskiev G, Mukhin E, Tolstyakov S, Andrew P, Kempenaars M, Vayakis G, Walsh M. Nd:YAG lasers for ITER divertor Thomson scattering. FUSION ENGINEERING AND DESIGN 2019. [DOI: 10.1016/j.fusengdes.2019.01.147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kirk RJ, Lawes CM, Farrington W, Misur P, Walker ML, Kluger M, Seow MY, Andrew P. Post-operative mortality rates for neck of femur fracture at Waitemata District Health Board. THE NEW ZEALAND MEDICAL JOURNAL 2019; 132:17-25. [PMID: 30789885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIM Mortality rates of up to 38% at one year have been reported following surgery for neck of femur fractures. The aim of this review is to evaluate the post-operative mortality rates and trends over time for patients with fractured neck of femur at Waitemata District Health Board. METHOD A retrospective cohort study of all patients who received surgery following a neck of femur fracture at Waitemata District Health Board between 2009 and 2016. Inpatient data was retrieved from electronic hospital records and mortality rates from the Ministry of Health, New Zealand. Analyses included crude mortality rates and trends over time, and time-to-theatre from presentation with neck of femur fracture. RESULTS A total of 2,822 patients were included in the study; mean age 81.9 years, 70.4% female and 29.6% male. Overall post-operative crude rates for inpatient, 30-day and one-year mortality were 3.7%, 7.2% and 23.8% respectively. Adjusted analyses showed a statistically significant decrease in mortality rates between 2009 and 2016 at inpatient (p=0.001), 30 days (p=<0.001) and one year (p=<0.001) time periods. There was also a significant association between time-to-theatre and mortality at inpatient (p=0.002), 30 days (p=0.0001), and one year (p=0.0002) time periods. CONCLUSION Mortality rates following surgery for fractured NOF have significantly improved over recent years at Waitemata District Health Board. Reduced time-to-theatre is associated with decreased inpatient, 30-day and one-year mortality.
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Ng J, Andrew P, Muir P, Greene M, Mohan S, Knight J, Hider P, Davis P, Seddon M, Scahill S, Harrison J, Zhou L, Selak V, Lawes C, Galgali G, Broad J, Crawley M, Pevreal W, Houston N, Brott T, Ryan D, Peach J, Brant A, Bramley D. Feasibility and reliability of clinical coding surveillance for the routine monitoring of adverse drug events in New Zealand hospitals. THE NEW ZEALAND MEDICAL JOURNAL 2018; 131:46-60. [PMID: 30359356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM To explore the feasibility and reliability of Clinical Coding Surveillance (CCS) for the routine monitoring of Adverse Drug Events (ADE) and describe the characteristics of harm identified through this approach in a large district health board (DHB). METHOD All hospital admissions at Waitemata DHB from 2015 to 2016 with an ADE-related ICD10-AM code of Y40-Y59, X40-X49 or T36-T50 were extracted from clinical coded data. The data was analysed using descriptive statistics, statistical process control and Pareto charts. Two clinicians assessed a random sample of 140 ADEs for their accuracy against what was clinically documented in medical records. RESULTS A total of 11,999 ADEs were identified in 244,992 admissions (4.9 ADEs per 100 admissions). ADEs were more prevalent in older adults and associated with longer average length of stays and medicines such as analgesics, antibiotics, anticoagulants and diuretics. Only 2,164 (18%) of ADEs were classified as originating within hospital. Of ADEs originating outside of the hospital, the main causes were poisoning by psychotropics, anti-epileptics and anti-parkinsonism agents and non-opioid analgesics. Clinicians agreed that 91% of ADE positive admissions were accurately classified as per clinical documentation. CONCLUSION CCS is a feasible and reliable approach for the routine monitoring of ADEs in hospitals.
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Martin A, Andrew P, Jokinen T, Komarov V, Kukushkin A, Loarte A, Maruyama S, Merola M, Palmer J, Pearce R, Pick M, Pitts R, Walker C. ITER Divertor System Integration. FUSION SCIENCE AND TECHNOLOGY 2017. [DOI: 10.13182/fst09-a8877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Kim J, Andrew P, Reichle R. Plasma-Wall-Interaction Diagnostics in ITER: Dust, Erosion, and Tritium Retention. FUSION SCIENCE AND TECHNOLOGY 2017. [DOI: 10.13182/fst12-a13386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Ng J, Andrew P, Crawley M, Pevreal W, Peach J. Assessing a hospital medication system for patient safety: findings and lessons learnt from trialling an Australian modified tool at Waitemata District Health Board. THE NEW ZEALAND MEDICAL JOURNAL 2016; 129:63-77. [PMID: 26914423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM To undertake a review of Waitemata District Health Board's (WDHB) hospital medication system for patient safety assessment and improvement purposes. METHODS A multidisciplinary group rated current WDHB hospital medication systems against the Medication Safety Self-Assessment for Australian Hospitals (MSSA-AH) criterion of 247 aspirational practices using a five point scale ("no" to "fully implemented"). Items with a lesser extent of implementation represented practice gaps. The MSSA-AH database and weighted adjustment scoring system generated an overall hospital score. RESULTS Of the maximum possible score that could be obtained had all MSSA-AH practices been implemented, WDHB scored 63% and this was comparable to other demographically similar hospitals in Australia. Lowest scoring practices needing improvement related to staffing. Conflict resolution was a previously unidentified practice gap. Previously identified gaps, such as those relating to electronic medication systems suggested ongoing implementation was required. CONCLUSION This was the first documented use of the MSSA-AH's in a New Zealand hospital setting and helped WDHB identify areas in need of further improvement. The unique generation of a percentage score helped simplify understanding for non-technical stakeholders. Future repeated assessments would help WDHB track progress. Implicit benefits, such as stakeholder engagement, were observed. The MSSA-AH may be useful in other hospital settings.
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Andrew P, O'Connor S, Valdes M, Majeed H, Montenero A. DO STANDARD HEART FAILURE MEDICATIONS PREVENT FALL IN LVEF IN BREAST CANCER PATIENTS GIVEN TARGETED THERAPY? Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Majeed H, Montenero A, Valdes M, O'Connor S, Andrew P. P081 Do standard heart failure medications prevent fall in LVEF in patients on trastuzumab? Breast 2015. [DOI: 10.1016/s0960-9776(15)70126-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Johnson C, Andrew P, Sulpher J, Majeed H, Graham N, Turek M, Susan D. DATA-DRIVEN TIMING OF OPTIMAL LV EJECTION FRACTION ASSESSMENT IN BREAST CANCER PATIENTS EXPOSED TO TRASTUZUMAB. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Sulpher J, Andrew P, Majeed H, Johnson C, Graham N, Dent S. Data-Driven Timing of Optimal Lvef Assessment in Breast Cancer Patients Exposed to Trastuzumab. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu327.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Liu SC, Gillespie J, Atchison N, Andrew P. The recovery programme for the Regent honeyeaterAnthochaera phrygia:an example of conservation collaboration in Australia. ACTA ACUST UNITED AC 2013. [DOI: 10.1111/izy.12040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Murtagh L, Gallagher TH, Andrew P, Mello MM. Disclosure-and-resolution programs that include generous compensation offers may prompt a complex patient response. Health Aff (Millwood) 2013; 31:2681-9. [PMID: 23213152 DOI: 10.1377/hlthaff.2012.0185] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Under "disclosure-and-resolution" programs, health systems disclose adverse events to affected patients and their families; apologize; and, where appropriate, offer compensation. Early adopters of this approach have reported reduced liability costs, but the extent to which these results stem from effective disclosure and apology practices, versus compensation offers, is unknown. Using survey vignettes, we examined the effects of different compensation offers on individuals' responses to disclosures of medical errors compared to explanation and apology alone. Our results show that although two-thirds of these individuals desired compensation offers, increasing the offer amount did not improve key outcomes. Full-compensation offers did not decrease the likelihood of seeking legal advice and increased the likelihood that people perceived the disclosure and apology as motivated by providers' desire to avoid litigation. Hospitals, physicians, and malpractice insurers should consider this complex interplay as they implement similar initiatives. They may benefit from separating disclosure conversations and compensation offers and from excluding physicians from compensation discussions.
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Patel K, Udintsev V, Hughes S, Walker C, Andrew P, Barnsley R, Bertalot L, Drevon J, Encheva A, Kashchuk Y, Maquet P, Pearce R, Taylor N, Vayakis G, Walsh M. ITER diagnostic system: Vacuum interface. FUSION ENGINEERING AND DESIGN 2013. [DOI: 10.1016/j.fusengdes.2013.01.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Hayn MH, Andrew P, Hellenthal NJ, Poch MA, O’Malley RL, Guru KA. Robot-assisted radical cystectomy: Oncologic results of 150 consecutive cases with a median 19-month follow-up. J Am Coll Surg 2011. [DOI: 10.1016/j.jamcollsurg.2011.06.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Reichle R, Andrew P, Counsell G, Drevon JM, Encheva A, Janeschitz G, Johnson D, Kusama Y, Levesy B, Martin A, Pitcher CS, Pitts R, Thomas D, Vayakis G, Walsh M. Defining the infrared systems for ITER. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2010; 81:10E135. [PMID: 21033997 DOI: 10.1063/1.3491199] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The International Thermonuclear Experimental Reactor will have wide angle viewing systems and a divertor thermography diagnostic, which shall provide infrared coverage of the divertor and large parts of the first wall surfaces with spatial and temporal resolution adequate for operational purposes and higher resolved details of the divertor and other areas for physics investigations. We propose specifications for each system such that they jointly respond to the requirements. Risk analysis driven priorities for future work concern mirror degradation, interfaces with other diagnostics, radiation damage to refractive optics, reflections, and the development of calibration and measurement methods for varying optical and thermal target properties.
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