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Biomedical subjects

Justin Roake

Publications and source records attributed to Justin Roake.

9 recordsLinked to original sources
PubMed2006

Management of risk factors: a survey of New Zealand vascular surgeons.

AIM: Patients with peripheral occlusive arterial disease (POAD) suffer significant morbidity and mortality from cardiovascular events that may be reduced by appropriate risk factor management. The aim of this study was to document the opinion of New Zealand vascular surgeons regarding risk factor management in patients with POAD. METHODS: A questionnaire was emailed to 42 New Zealand vascular surgeons. Surgeons were asked if they checked risk factors in patients with POAD and who they thought should manage these risk factors. The survey was then re-emailed to non-responders after 3 weeks and subsequently posted to the remaining non-responders with a reply paid envelope after a further 3 weeks. RESULTS: The overall response rate was 83% (35/42). Thirty-four of the 35 surgeons (97%) stated that they routinely asked smoking history, 69% monitored blood pressure, 74% checked cholesterol level, 57% checked blood glucose level, and none checked homocysteine level, although 43% consider hyperhomocysteinaemia to be a risk factor for atherosclerosis. Vascular surgeons considered general practitioners should play a pivotal role in the management of cardiovascular risk factors. A variable proportion of vascular surgeons thought that the vascular team should also be involved in the management of smoking (46%), hyperlipidaemia (20%), hyperhomocysteinaemia (23%), and prescription of antiplatelet therapy (69%). CONCLUSIONS: Modification of risk factors in patients with POAD is imperative but opinion on who is responsible for risk factor management lacks consensus. It is more important that risk factor modification occurs than who oversees such intervention.

Antihypertensive Agents↗
PubMed2006

Treating claudication in 5 words (stop smoking and keep walking) is no longer enough: an audit of risk factor management in patients prescribed exercise therapy in New Zealand.

AIM: To assess the documentation and modification of vascular risk factors in patients with intermittent claudication enrolled in an exercise programme in Christchurch, New Zealand. PATIENTS/METHOD: A retrospective review of case notes of patients who presented to the vascular outpatient department with intermittent claudication and were given "Green Prescriptions" for an exercise programme was performed. Referral letters, clinic letters, vascular nurse notes, and handwritten hospital notes were searched for evidence of documentation of risk factors for atherosclerosis. Modification of these risk factors was also noted. Positive attempts at risk factor modification included starting or asking the GP to start a medication or asking the GP to assist with smoking cessation. RESULTS: Sixty patient notes were reviewed which included 81 referral letters (66 from GPs), 118 surgeon letters/clinic notes, and 43 vascular nurse assessments. Of the 60 patients referred, risk factor documentation (positive or negative) was antiplatelet therapy (40), hypertension (48), hyperlipidaemia (39), current tobacco use (40), diabetes mellitus (37), and coronary artery disease (38). Vascular surgeons saw 58 patients and documentation was antiplatelet therapy (42), hypertension (46), hyperlipidaemia (45), current tobacco use (48), diabetes mellitus (44), and coronary artery disease (29). Attempted modification of risk factors by vascular surgeons occurred in 12 patients for antiplatelet therapy, 11 patients for lipid lowering therapy, and 10 for current smokers. Forty-three vascular nurse assessments resulted in documentation of antiplatelet therapy (0), hypertension (42), hyperlipidaemia (42), current tobacco use (43), diabetes mellitus (42), and coronary artery disease (6). CONCLUSION: There is suboptimal communication of vascular risk factors by referrers to specialist vascular services. The recording and modification of risk factors for atherosclerosis in our unit compares favourably with other reported series, but improvement is needed. Furthermore, the role of clinicians with an interest in risk factor management, and patients' understanding of their vascular risk factors, needs clarification.

Adult↗
PubMed2006

Sonic hedgehog expression in the development of hindgut in ETU-exposed fetal rats.

Sonic hedgehog (Shh) has been shown to be involved in the morphogenesis of many organ systems including the notochord, floor plate and limbs, as well as in the development of the left-right axis in vertebrates. Recent evidence suggests the Shh cascade plays a crucial role in the development of the foregut and hindgut. We have previously shown that prenatal exposure of fetal rats to ethylenethiourea (ETU) induces hindgut malformations and other abnormalities of the VACTERL association. The aim of this study was to determine the pattern of expression of Shh and its downstream genes during hindgut development in ETU-exposed embryos with anorectal malformations (ARMs). Pregnant Sprague-Dawley rats were mated together overnight and a positive vaginal plug was marked as gD0. On gD10, 1% ETU (125 mg/kg) was given to the experimental group and controls received the same volume of saline. Embryos were collected from both groups at gD12-16. The developing hindgut of each embryo was dissected under magnification and snap frozen. Highly purified RNA was isolated from each hindgut and first strand cDNA was prepared with appropriate negative controls. Reverse transcriptase (RT) polymerase chain reaction (PCR) was done to determine the transcripts of Shh in each sample and quantitative real-time PCR was carried out to show relative quantitative expression of Shh at each time point. Shh was detected in all samples confirming that Shh is active during the process of hindgut development in fetal rats. Relative quantitation demonstrated that Shh expression shows time-dependent changes in the developing hindgut of ETU-exposed rat embryos, and when results were compared with control samples, there was significant decrease in expression on gD14 and 15, when the cloaca normally separates into the rectum and urethra occurs in the rat fetus. The misregulated expression of Shh in the hindgut of ETU-exposed rat embryos suggests that ETU may interfere with Shh signalling. Downregulation at the time of cloacal separation into rectum and urethra indicates that Shh plays a crucial role in the development of hindgut.

Abnormalities, Multiple↗
PubMed2005

Informed consent for vascular intervention.

AIM: To audit documentation of the process of informed consent in patients undergoing vascular surgical and radiological procedures. METHOD: A retrospective audit of randomly selected elective vascular radiological and surgical admissions was undertaken at Christchurch Hospital (Christchurch, New Zealand) to assess documented evidence of the consent process. Clinic letters, handwritten entries in patient notes, and consent forms were scrutinised and data collated on which medical practitioners took consent, what details of the consent process were documented, and what additional information was made available to patients. RESULTS: 100 sets of notes were reviewed (surgical n=51, radiological n=49). For patients undergoing vascular surgery, the consent form was signed by a consultant in 2 (4%) sets of notes compared to 46 (94%) for patients undergoing vascular radiological intervention (p<0.001). All radiology consent forms were signed on the day of the procedure whereas 43 (84%) of surgical consent forms were signed before the day of surgery (p<0.01). Documentation that risks had been discussed with the patient was present in 44 (86%) sets of surgical notes compared to 20 (41%) radiology notes (p<0.001). Additional information (e.g. College of Surgeons' information leaflets) was supplied to 6 (12%) surgical patients and none of the patients undergoing radiological intervention (p<0.05). CONCLUSIONS: In our centre, documentation of the process of informed consent compares favourably with the published literature. This study demonstrates significant differences in documentation between surgery and radiology.

Adult↗
PubMed2005

Prioritisation of elective surgery in New Zealand: The Reliability Study.

AIMS: This paper describes the rationale and methodology of a study assessing the reliability of tools for clinical prioritisation (Clinical Priority Assessment Criteria [CPAC]) of patients for elective surgery in New Zealand. METHODS: Surgeons from three specialties (general, vascular, and orthopaedic surgery) completed a computerised evaluation rating clinical vignettes across a range of diagnoses using several priority tools. The study design is described and an outline of the individual tool development and definitions is given. RESULTS: Of the 124 surgeons that participated in this study, 48% (60) were general surgeons, 21% (26) were vascular surgeons and 31% (38) were orthopaedic surgeons. The response rates in the first phase of data collection were 67%, 79%, and 63% for general, vascular, and orthopaedic surgery respectively. Completion rates were high with 100%, 93%, and 98% of the same groupings of surgeons completing the first round evaluations. A further 77% to 89% of the participants from the first round also completed the re-test evaluation. CONCLUSION: This study indicates that assessment of the reliability of CPAC tools currently in use in New Zealand is feasible using a vignette-based approach. In the future, study designs that allow for some face-to-face contact may be preferable for achieving optimal response and completion rates among surgeons. Further work from this study will focus on the individual results for each specialty and examining whether altering ethnicity status in vignettes had any effect on scoring behaviour.

Activities of Daily Living↗
PubMed2002

Serum-derived IgG1-mediated immune exclusion as a mechanism of protection against H. pylori infection.

The induction of protective immunity against Helicobacter challenge in a murine model was found to correlate with the magnitude of IgG (serum and gastric lavage) responsiveness to intra-nasal (i.n.) immunisation. IgG1-secreting hybridoma backpacks in Helicobacter pylori (H. pylori)-infected mice revealed serum transudation into the stomach. A Lpp20-specific monoclonal antibody was associated with significantly reduced H. pylori colonisation. Histology revealed aggregates of the remaining H. pylori in these mice, suggesting a role for IgG1-mediated immune exclusion of the bacteria. In vitro immunogold electron microscopy supported this hypothesis, but also suggested that a threshold of H. pylori-specific antibody needs to be maintained if immune exclusion by the host is to overcome immune evasion by the bacteria.

Administration, Intranasal↗