PubMed Health⌕ Search

Biomedical subjects

Peter Davis

Publications and source records attributed to Peter Davis.

At least 19 recordsLinked to original sources
PubMed2006

Dietary intakes by different markers of socioeconomic status: results of a New Zealand workforce survey.

AIM: To compare dietary nutrient and food group intakes of men and women in a work force with various measures of socioeconomic status. METHODS: Daily nutrient intakes were calculated from a self-administered food frequency questionnaire from participants in a cross-sectional health screening survey of a multiracial workforce carried out between May 1988 and April 1990. Participants comprised 5517 Maori, Pacific Island and Other workers (3997 men, 1520 women) aged 40 to 78 years. Socioeconomic measures included the New Zealand Socioeconomic Index (NZSEI), gross household income and level of education. RESULTS: In general, there were trends across socioeconomic status levels with lower NZSEI occupational classes, lower family income, and non-tertiary education groups having lower intakes of dietary fibre, calcium, and alcohol and higher intakes of dietary cholesterol. These were reflected by their lower intakes of fruit, vegetables, milk, cheese and wine, and higher intakes of eggs. However, associations were not consistent across all measures of socioeconomic status. CONCLUSIONS: Dietary intakes showed a generally more adverse pattern in the lower socioeconomic strata. NZSEI and education were associated with food group selections, whereas nutrient intakes were associated with income. More money available for food could improve nutrition. Public health programmes to improve nutrition need to be targeted at these groups and be coupled with personal support and structural changes that make "healthy choices the easy choices".

Adult↗
PubMed2006

Quality of hospital care for Māori patients in New Zealand: retrospective cross-sectional assessment.

BACKGROUND: New Zealand has a substantial indigenous minority--the Māori--that has considerably worse health status than the majority population. We aimed to assess possible disparities in quality of hospital care for Māori with data on preventable adverse events as an indicator of suboptimum treatment. METHODS: We undertook a nationally representative cross-sectional survey of admissions to general public hospitals with more than 100 beds providing acute care. A sample of 6579 patients admitted in 1998 to 13 hospitals was selected by stratified systematic list sample. We did a two-stage retrospective assessment of records by structured implicit review. Outcome measures were occurrence, effect, and preventability of adverse events. FINDINGS: Māori accounted for just greater than 15% of admissions and were on average younger, were more likely to be from from deprived areas, had a different case mix, and were in hospital for a shorter stay compared with patients of non-Māori/non-Pacific origin. Overall, after age standardisation, 14% of admissions for Māori were associated with an adverse event, compared with 11% for non-Māori/non-Pacific patients (p=0.01 for difference between groups). For preventable, in-hospital events, this disparity persisted after controlling for age, other sociodemographic factors, and case mix (adjusted odds ratio 1.47; p=0.05). Analysis of potential causal factors showed no markedly or consistently different pattern between the groups. INTERPRETATION: Despite a predominantly publicly funded hospital system, our findings suggest that hospital care received by Māori is marginally poorer than that received by New Zealand citizens of non-Māori/non-Pacific origin. Although no cause specific to Māori was evident, various policy and system issues can be addressed.

Adolescent↗
PubMed2006

Caffeine therapy for apnea of prematurity.

BACKGROUND: Methylxanthines reduce the frequency of apnea of prematurity and the need for mechanical ventilation during the first seven days of therapy. It is uncertain whether methylxanthines have other short- and long-term benefits or risks in infants with very low birth weight. METHODS: We randomly assigned 2006 infants with birth weights of 500 to 1250 g during the first 10 days of life to receive either caffeine or placebo, until drug therapy for apnea of prematurity was no longer needed. We evaluated the short-term outcomes before the first discharge home. RESULTS: Of 963 infants who were assigned to caffeine and who remained alive at a postmenstrual age of 36 weeks, 350 (36 percent) received supplemental oxygen, as did 447 of the 954 infants (47 percent) assigned to placebo (adjusted odds ratio, 0.63; 95 percent confidence interval, 0.52 to 0.76; P<0.001). Positive airway pressure was discontinued one week earlier in the infants assigned to caffeine (median postmenstrual age, 31.0 weeks; interquartile range, 29.4 to 33.0) than in the infants in the placebo group (median postmenstrual age, 32.0 weeks; interquartile range, 30.3 to 34.0; P<0.001). Caffeine reduced weight gain temporarily. The mean difference in weight gain between the group receiving caffeine and the group receiving placebo was greatest after two weeks (mean difference, -23 g; 95 percent confidence interval, -32 to -13; P<0.001). The rates of death, ultrasonographic signs of brain injury, and necrotizing enterocolitis did not differ significantly between the two groups. CONCLUSIONS: Caffeine therapy for apnea of prematurity reduces the rate of bronchopulmonary dysplasia in infants with very low birth weight. (ClinicalTrials.gov number, NCT00182312.).

Apnea↗
PubMed2006

Representative case series from New Zealand public hospital admissions in 1998--III: adverse events and death.

AIMS: To examine a representative series of adverse events in New Zealand public hospitals where death was the final outcome recorded, with a view to determining the relationship between adverse event and death. METHODS: A review was carried out of the 38 adverse events (AEs) in the New Zealand Quality of Healthcare Study where death was the outcome, and categories of relationship were established. These were identified from the total of 850 AEs determined by two-stage retrospective review of a representative sample of 6579 medical records drawn from 13 NZ public hospitals in 1998. A stricter definition of AEs, comparable with American studies, was then applied to estimate rates of death associated with AEs. RESULTS: There were 118 deaths at discharge identified in the sample of medical records, giving a rate of 18.0 deaths per 1000 admissions overall. A total of 30 deaths, either at or after discharge, were associated with AEs (4.6 per 1000 admissions); 19 being judged attributable to the AE either "definitely" (10) or probably (9), giving a combined rate of 2.8 AE-attributable deaths per 1000 admissions. The "definite" group had an age, comorbidity, and added-bed-days profile that was close to the average for all deaths associated with an AE. The "probable" group departed from this profile in being younger, exhibiting higher comorbidity, and having twice the added bed-days. Based on population life tables, the average years of life lost was 11.8 years for the definite group and 25.0 years for the probable group. Assessed on the preventability of the associated AE, it was estimated that 2.2 deaths per 1000 admissions were highly preventable. However, once deaths that were not judged to be attributable to the AE were excluded, the rate reduced to 1.3 AE-preventable deaths per 1000. CONCLUSIONS: Because of the nature of the record review procedure used in the New Zealand Quality of Healthcare Study, a finding of death did not necessarily mean that an adverse event and death were causally related. Indeed, it is possible that extrapolations of mortality rates in this and other similar studies over-estimate by about a half the number of deaths caused by healthcare management.

Adolescent↗
PubMed2006

Indomethacin prophylaxis, patent ductus arteriosus, and the risk of bronchopulmonary dysplasia: further analyses from the Trial of Indomethacin Prophylaxis in Preterms (TIPP).

OBJECTIVES: To determine the risk of bronchopulmonary dysplasia (BPD) in subgroups of infants with and without patent ductus arteriosus (PDA) who were randomized to indomethacin prophylaxis or placebo, and to examine whether adverse drug effects on edema formation and oxygenation may explain why indomethacin prophylaxis does not reduce BPD. STUDY DESIGN: We studied 999 extremely low birth weight infants who participated in the Trial of Indomethacin Prophylaxis in Preterms (TIPP) and who survived to a postmenstrual age of 36 weeks. RESULTS: The incidence of BPD in the 2 subgroups of infants with PDA was 52% (55/105) after indomethacin prophylaxis and 56% (137/246) after placebo. In contrast, rates of BPD in the 2 subgroups without a PDA were 43% (170/391) after indomethacin prophylaxis and 30% (78/257) after placebo (P [interaction] = .015). Logistic regression analysis with adjustment for prognostic baseline factors showed that adverse and independent effects of indomethacin prophylaxis on the need for supplemental oxygen and on weight loss by the end of the first week of life may increase the risk of BPD in infants without PDA. CONCLUSIONS: Harmful side effects on oxygenation and edema formation may explain why indomethacin prophylaxis does not prevent BPD even though it reduces PDA.

Bronchopulmonary Dysplasia↗
PubMed2006

Modeling eligibility under national systems of compensation for treatment injury.

How can different schemes of compensation for treatment injury be evaluated? This article offers an empirical approach to assessment based on the simulation of alternative models of eligibility using real-world data. It draws on information about adverse events generated from a representative survey of public hospital admissions in New Zealand and classifies these under a range of eligibility criteria for different possible compensation systems. These are then evaluated according to a number of policy design considerations, using variables available from the New Zealand study.

Adolescent↗
PubMed2005

Representative case series from public hospital admissions 1998 II: surgical adverse events.

AIMS: To examine a representative case series of surgical adverse events in New Zealand public hospitals with a view to assessing their occurrence, causation, patient impact and preventability. METHODS: An analysis was carried out on 326 surgical adverse events classified by reviewing physicians. These were identified from among 850 adverse events determined by two-stage retrospective review of a representative sample of 6579 medical records drawn from 13 public hospitals in 1998. RESULTS: From the four surgical categories--operative, fracture management, therapeutic, and system--there were 326 surgical adverse events, 38.4% of all adverse events identified. Surgical events had the same profile as adverse events overall. Four-fifths of surgical events were directly related to a surgical operation; these affected older patients and were less preventable than adverse events overall. A third of operative events were attributable to technical problems, another third to infections, with the remainder divided between haemorrhagic and cardiovascular complications. Therapeutic and system events had high preventability, and a significant proportion was related to delay in treatment. Half of events in fracture management were infection-related, patients were younger and, system events apart, had fewer extra bed days than other surgical events or events overall. The major causes of preventable events were avoidable delay in treatment (19.9%) and inadequate monitoring and supervision (13.6%), followed by personnel practising outside their expertise (8.0%) and inappropriate treatment (7.4%). CONCLUSIONS: On average, surgical events are associated with an extra 9.9 days in hospital, but they have a lower level of preventability than adverse events overall. Problems of infection, delay, and other aspects of the quality of care are identified for further consideration.

Adult↗
PubMed2005

Earth's free oscillations excited by the 26 December 2004 Sumatra-Andaman earthquake.

At periods greater than 1000 seconds, Earth's seismic free oscillations have anomalously large amplitude when referenced to the Harvard Centroid Moment Tensor fault mechanism, which is estimated from 300- to 500-second surface waves. By using more realistic rupture models on a steeper fault derived from seismic body and surface waves, we approximated free oscillation amplitudes with a seismic moment (6.5 x 10(22) Newton.meters) that corresponds to a moment magnitude of 9.15. With a rupture duration of 600 seconds, the fault-rupture models represent seismic observations adequately but underpredict geodetic displacements that argue for slow fault motion beneath the Nicobar and Andaman islands.

Journal Article↗
PubMed2005

New Zealand general practitioners' characteristics and workload: the National Primary Medical Care Survey.

AIMS: To describe the characteristics and workload of New Zealand general medical practitioners (GPs). METHODS: Data were collected from a stratified random sample of GPs as part of the The National Primary Medical Care Survey carried out in 2001. RESULTS: Data were submitted by 244 practitioners; a 62% response rate. Women made up 63% of the GP workforce aged under 40 years, but only 19% of those aged over 50 years. New Zealand graduates made up 69% of GPs; graduates from other areas occupied particular niches in the GP workforce. Each week, GPs worked (on average) 4 days and saw 102 patients. Eighty percent undertook after-hours work, and the average on-call roster was 1-in-8. At least 8% of visits to GPs occurred after-hours. Parameters of workload were lower for women and for those working in community-owned clinics, and higher for those working outside cities. CONCLUSIONS: An increasing proportion of GPs are women, and more GPs are working part time. In addition, if the changes in primary healthcare add to GPs' responsibilities, then more doctors will be needed. At present, GPs' workload is high in rural areas, which suggests inadequate recruitment; the distribution of GPs is a more important workforce issue than absolute numbers.

Adult↗
PubMed2005

Neonates do not need to be handled for radiographs.

BACKGROUND: The handling of sick neonates may have detrimental effects such as hypoxia or bradycardia. Such handling is inevitable due to the frequent need for practical procedures; however, minimising handling reduces these adverse events and may improve outcome. Radiography is one of the commonest procedures performed on neonates. Usually the infant is lifted and placed onto the radiographic cassette; however, modern incubators often incorporate a tray beneath the mattress in which the radiographic cassette can be placed without the need to disturb the infant. OBJECTIVE: To compare the quality of chest radiographs taken using the standard direct contact method, with those taken using the under-tray technique. MATERIALS AND METHODS: A series of chest radiographs taken over a 21-month period were analysed independently by two consultant paediatric radiologists unaware of the radiographic details. The position of the radiograph, i.e. direct contact or under-tray, was determined by the radiographer. Radiographic quality was scored on the following features: exposure, blurring, rotation, cut-off or coning, and side markers. A subjective score was also included. The results from each radiologist were analysed separately. RESULTS: Seventy chest radiographs were analysed-25 standard method, 45 under-tray. A statistically significant advantage for the under-tray method was seen on two analyses-radiologist 1 for exposure, and radiologist 2 for cut-off. No other significant differences were noted. There were no differences in the infants' weights or radiation exposure. CONCLUSIONS: The under-tray method for taking radiographs may produce films of at least equivalent quality to the standard method. Since the standard method involves handling with potential desaturation and bradycardia, this technique should cease.

Chi-Square Distribution↗
PubMed2005

Primary care teams: New Zealand's experience with community-governed non-profit primary care.

Community-governed non-profit primary care organisations started developing in New Zealand in the late 1980s with the aim to reduce financial, cultural and geographical barriers to access. New Zealand's new primary health care strategy aims to co-ordinate primary care and public health strategies with the overall objective of improving population health and reducing health inequalities. The purpose of this study is to carry out a detailed examination of the composition and characteristics of primary care teams in community-governed non-profit practices and compare them with more traditional primary care organisations, with the aim of drawing conclusions about the capacity of the different structures to carry out population-based primary care. The study used data from a representative national cross-sectional survey of general practitioners in New Zealand (2001/2002). Primary care teams were largest and most heterogeneous in community-governed non-profit practices, which employed about 3% of the county's general practitioners. Next most heterogeneous in terms of their primary care teams were practices that belonged to an Independent Practitioner Association, which employed the majority of the country's general practitioners (71.7%). Even though in absolute and relative terms the community-governed non-profit primary care sector is small, by providing a much needed element of professional and organisational pluralism and by experimenting with more diverse staffing arrangements, it is likely to continue to have an influence on primary care policy development in New Zealand.

Community Participation↗
PubMed2005

Male/female differences in indomethacin effects in preterm infants.

To test whether indomethacin prophylaxis has sex-mediated effects on severe intraventricular hemorrhage (grade III and IV) and on long-term outcomes in extremely-low-birth-weight infants. A secondary analysis was performed in the entire "Trial of Indomethacin Prophylaxis in Preterms study" cohort. The results suggest a weak differential treatment effect of indomethacin by sex.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2005

Does community-governed nonprofit primary care improve access to services? Cross-sectional survey of practice characteristics.

This study compared community-governed nonprofit and for-profit primary care practices in New Zealand to test two hypotheses: (1) nonprofits reduce financial and cultural barriers to access; and (2) nonprofits do not differ from for-profits in equipment, services, service planning, and quality management. Data were obtained from a nationally representative cross-sectional survey of GPs. Practices were categorized by ownership status: private community-governed nonprofit or private for-profit. Community-governed nonprofits charged lower patient fees per visit and employed more Maori and Pacific Island staff, thus reducing financial and cultural barriers to access compared with for-profits. Nonprofits provided a different range of services and were less likely to have specific items of equipment; they were more likely to have written policies on quality management, complaints, and critical events, and to carry out locality service planning and community needs assessments. The findings support the shift to nonprofit community governance occurring in New Zealand and elsewhere.

Community Health Services↗
PubMed2004

"Tough but fair"? The active management of the New Zealand drug benefits scheme by an independent Crown agency.

For just over a decade, New Zealand has relied on an independent Crown agency to manage the public drug benefits scheme. It was established after a period of industry litigation and unsustainable budgetary increases. The agency has successfully contained prices, saving the equivalent to its originally allocated budget every year, despite a 50% increase in volumes. It shares features with similar agencies elsewhere in the world, particularly in its independence and its operational methodology. Opposition from the industry and ambivalence in the medical community remain matters of concern. The fate of such agencies is inextricably linked to wider regulatory and policy settings in the health sector.

Budgets↗
PubMed2004

Representative case series from public hospital admissions 1998 I: drug and related therapeutic adverse events.

AIMS: To examine a representative case series of drug and related therapeutic adverse events in New Zealand public hospitals with a view to assessing their occurrence, causation, patient impact and preventability. METHODS: An analysis was carried out on 192 drug and related therapeutic adverse events classified by reviewing physicians. These were identified from among 850 adverse events determined by two-stage retrospective review of a representative sample of 6579 medical records drawn from 13 public hospitals in 1998. RESULTS: One fifth of all adverse events were in the combined group, comprising drug (15.4%) and related therapeutic (7.3%) incidents. In comparison with other adverse events these incidents appeared to be more common among older patients, were less likely to have occurred in hospital, and had slightly less impact on patients. Cardiovascular drugs accounted for nearly half of drug events; poor infection management, by contrast, was the dominant factor among related therapeutic events, with problems in cardiovascular management also important. Inadequate monitoring and follow up of medication was identified as the most common reason for failure to prevent both drug and related therapeutic adverse events. CONCLUSIONS: This study shows that morbidity related to medications is extensive. Drug-related adverse events are frequent and many are preventable. Better monitoring and more appropriate medication choice for individuals are the most common prevention strategies identified.

Adult↗
PubMed2004

Bilateral peripheral T-cell lymphoma of the fallopian tubes.

BACKGROUND: Lymphoma of the female genital tract is rare, and usually involves the ovaries or the uterus. Most cases of fallopian tube lymphoma reflect disease arising in the ovaries. All previously reported cases of primary lymphoma of the fallopian tube were of B cell lineage. CASE: A 51-year-old woman presented with systemic upset and a pelvic mass. At laparotomy, both fallopian tubes were inflamed and histological examination revealed peripheral T-cell lymphoma. At staging, she had IIB(E) disease, and she was treated with six cycles of CHOP-M chemotherapy. CONCLUSION: Our case is unusual in that this is the first described case of peripheral T-cell lymphoma arising in the fallopian tubes and is moreover unusual because of the involvement of both fallopian tubes without involvement of other gynaecological organs. The clinical course was favourable with complete remission maintained for more than 5 years.

Fallopian Tube Neoplasms↗