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Biomedical subjects

Peter Herbison

Publications and source records attributed to Peter Herbison.

At least 19 recordsLinked to original sources
PubMed2007

Global Registry of Acute Coronary Events (GRACE) hospital discharge risk score accurately predicts long-term mortality post acute coronary syndrome.

BACKGROUND: The Global Registry of Acute Coronary Events (GRACE) hospital discharge risk score (GRACE score) developed from a multinational registry involving all subsets of acute coronary syndrome (ACS) predicted 6-month survival. There is currently no validated risk model to predict mortality beyond 6 months. METHODS AND RESULTS: Of the 1143 consecutive patients with ACS admitted to coronary care unit in 2000 to 2002 (mean age, 64.9 +/- 12.6 years), 39% had ST-elevation myocardial infarction, 39% had non-ST-elevation infarction, and 22% had unstable angina. The mortality was 7.5% during index admission, 12.1% at 6 months, 14.8% at 1 year, 18.7% at 2 years, 25.0% at 3 years, and 39.2% at 4 years. The GRACE hospital discharge risk score calculated for 1057 hospital survivors discriminated survival from death at 6 months (C index, 0.81), 1 year (C index, 0.82), 2 years (C index, 0.81), 3 years (C index, 0.81), and 4 years (C index, 0.80). The risk score worked for all 3 subsets of ACS at all time points, with C index >0.75 in all analyses. A separate multivariable mortality model for these 1057 patients over the 4-years follow-up period identified 10 independent predictors of mortality. Seven were in the GRACE risk model (age, history of ischemic heart disease, heart failure, increased heart rate on admission, serum creatinine level, evidence of myonecrosis, not receiving in-hospital percutaneous coronary intervention). CONCLUSIONS: The GRACE postdischarge risk score contains relevant prognostic factors and accurately discriminate survivors from nonsurvivors over the longer term (up to 4 years) in all subsets of ACS patients.

Aged↗
PubMed2006

Adjustment of meta-analyses on the basis of quality scores should be abandoned.

OBJECTIVE: To find if a particular quality score was better than others at validly scoring the quality of randomized controlled trials, both by examining the consistency of dividing studies into high and low quality and using a large study as a reference standard. STUDY DESIGN AND SETTING: Observational study of meta-analyses from the Cochrane Library. These had to have binary outcomes that included more than 10 studies, one or more of which randomized more than 500 people into each group. RESULTS: Eighteen systematic reviews, with 65 meta-analyses using binary outcomes, were included and the included trials were scored for 43 different quality scores. None of these scores was better at dividing the studies in to low and high quality, and none of the scores was better over the 65 meta-analyses in making the result closer to the reference standard. CONCLUSION: None of the quality scores found appeared to measure quality validly. It is a mistake to assign meaning to the result of a quality score.

Bias↗
PubMed2006

Community hospital versus tertiary hospital comparison in the treatment and outcome of patients with acute coronary syndrome: a New Zealand experience.

AIMS: To compare the baseline characteristics, use of evidence-based medications, rate of revascularisation, and mortality of acute coronary syndrome (ACS) patients managed in a community hospital (Invercargill Hospital) without, and a tertiary teaching hospital (Dunedin Hospital) with, catheterisation and an interventional facility. METHODS: All patients with ACS admitted into Dunedin and Invercargill coronary care units (CCUs) between 2000-2002 inclusive were included in the study. RESULTS: Major baseline characteristics including age, history of diabetes, heart rate and systolic blood pressure at presentation were not different between the two centres. However, the proportions of patients with ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI) were higher in Invercargill CCU. More Invercargill patients experienced a cardiac arrest or clinical heart failure on hospital arrival. The use of evidence-based medications, coronary angiography (65.5% vs 20.2%, p<0.00001), and revascularisation (46.7% vs 16.4%, p<0.0005) were significantly higher in patients admitted into Dunedin CCU. The in-hospital, 6-months, and 1-year mortality was significantly lower (absolute mortality difference of 4.3%, 9.5%, and 10.0%, p<0.05, respectively) for ACS patients admitted into Dunedin CCU. Using multivariable logistic regression incorporating baseline characteristics, use of evidence-based medicine on arrival and transfer for angiography, the 1-year adjusted hazard ratio 3.02 (95%CI 1.60-5.71) remains significantly higher for patients in Invercargill Hospital. CONCLUSION: There was a disparity in ACS outcome between community and tertiary hospitals in New Zealand. The use of evidence-based medicine in all ACS patients should be encouraged even if revascularisation was not offered.

Acute Disease↗
PubMed2006

Lumbar segmental mobility disorders: comparison of two methods of defining abnormal displacement kinematics in a cohort of patients with non-specific mechanical low back pain.

BACKGROUND: Lumbar segmental rigidity (LSR) and lumbar segmental instability (LSI) are believed to be associated with low back pain (LBP), and identification of these disorders is believed to be useful for directing intervention choices. Previous studies have focussed on lumbar segmental rotation and translation, but have used widely varying methodologies. Cut-off points for the diagnosis of LSR & LSI are largely arbitrary. Prevalence of these lumbar segmental mobility disorders (LSMDs) in a non-surgical, primary care LBP population has not been established. METHODS: A cohort of 138 consecutive patients with recurrent or chronic low back pain (RCLBP) were recruited in this prospective, pragmatic, multi-centre study. Consenting patients completed pain and disability rating instruments, and were referred for flexion-extension radiographs. Sagittal angular rotation and sagittal translation of each lumbar spinal motion segment was measured from the radiographs, and compared to a reference range derived from a study of 30 asymptomatic volunteers. In order to define reference intervals for normal motion, and define LSR and LSI, we approached the kinematic data using two different models. The first model used a conventional Gaussian definition, with motion beyond two standard deviations (2sd) from the reference mean at each segment considered diagnostic of rotational LSMD and translational LSMD. The second model used a novel normalised within-subjects approach, based on mean normalised contribution-to-total-lumbar-motion. An LSMD was then defined as present in any segment that contributed motion beyond 2sd from the reference mean contribution-to-normalised-total-lumbar-motion. We described reference intervals for normal segmental mobility, prevalence of LSMDs under each model, and the association of LSMDs with pain and disability. RESULTS: With the exception of the conventional Gaussian definition of rotational LSI, LSMDs were found in statistically significant prevalences in patients with RCLBP. Prevalences at both the segmental and patient level were generally higher using the normalised within-subjects model (2.8 to 16.8% of segments; 23.3 to 35.5% of individuals) compared to the conventional Gaussian model (0 to 15.8%; 4.7 to 19.6%). LSMDs are associated with presence of LBP, however LSMDs do not appear to be strongly associated with higher levels of pain or disability compared to other forms of non-specific LBP. CONCLUSION: LSMDs are a valid means of defining sub-groups within non-specific LBP, in a conservative care population of patients with RCLBP. Prevalence was higher using the normalised within-subjects contribution-to-total-lumbar-motion approach.

Adult↗
PubMed2006

How many antibiotic prescriptions are unsubsidised in New Zealand?

AIMS: To determine the proportion of prescriptions for antibiotics which were unsubsidised, in one town in one year, and to use this to develop a model which could be used to estimate the number of unsubsidised prescriptions. METHODS: Data on all prescriptions for antibiotics during 2002 were extracted from pharmacy computers in one town. Data were obtained from PharmHouse database on all subsidised prescriptions from the town pharmacies during 2002. (The PharmHouse database is a subset of the New Zealand Health Information System database and contains records of all the claims for medicines dispensed within New Zealand.) These were compared and the proportion of unsubsidised prescriptions for each antibiotic calculated. Weighted linear regression was used to develop a model of the relationship between the percentage of each drug subsidised, and patient and prescription characteristics obtainable in PharmHouse. RESULTS: 64.4% of antibiotic dispensings in the study town were subsidised, and therefore captured by the PharmHouse database. The proportion varied substantially between different antibiotics. For particular drugs, the proportion of drugs unsubsidised could be predicted by the price of the drug, the number of days it was prescribed for, and the number of patients aged under six who received subsidised prescriptions. CONCLUSIONS: Previous studies using PharmHouse data are likely to have significantly underestimated the extent of drug use. Further research is needed on whether this model can help to estimate the extent of unsubsidised prescriptions.

Anti-Bacterial Agents↗
PubMed2006

Cephalometric correction factors for bite opening--a dry skull study.

The lateral cephalometric radiograph supplies the clinician with valuable information regarding the facial skeletal morphology of the patient, provided that it is taken correctly. These radiographs should be taken while the patient is occluding in maximum intercuspation, failing which the exposure is often repeated, leading to an increase in patient radiation dose as well as added cost in time and materials. This study investigated the relationship between limited bite opening and selected cephalometric variables. Thirty-one dry skulls were used and five splints were constructed for each skull giving increments of bite opening from 0 to 5 mm. Six lateral radiographs per skull were taken at each increment of bite opening. The radiographs were traced and the points plotted using a reflex metrograph. A linear relationship was found between bite opening and SNB, ANB, SN-mandibular plane, and SN-Y-axis angles. Errors in digitization, superimposition, and landmark identification were determined and found to be acceptable. Regression analysis produced a highly significant (P < 0.001) gradient for each of these angular relationships, allowing a set of correction factors to be produced, which can be applied to bite openings up to 5 mm.

Cephalometry↗
PubMed2006

Long-term results of Molteno implant insertion in cases of neovascular glaucoma.

OBJECTIVE: To describe the long-term outcomes of cases of neovascular glaucoma drained by Molteno implants. METHODS: A prospective study of 145 eyes (130 patients) followed up for a mean of 3.3 years (range, 0.02 year [5 days] to 18.1 years) in the province of Otago, New Zealand, from 1979 to 2002. RESULTS: Insertion of a Molteno implant controlled the intraocular pressure at 21 mm Hg or less with a probability (95% confidence interval) of 0.72 (0.64-0.80), 0.60 (0.51-0.69), and 0.40 (0.29-0.50) at 1, 2, and 5 years, respectively. Failure to control intraocular pressure at 1, 2, and 5 years was significantly correlated with persistent iris neovascularization (P<.001, P<.001, and P = .01, respectively). Visual acuity at final follow-up in nonenucleated eyes was maintained or improved in 56 eyes (39%) and deteriorated to light perception or better in 25 (17%) or no light perception in 47 (32%). Seventeen eyes (12%) were enucleated. CONCLUSIONS: The insertion of Molteno implants for neovascular glaucoma maintained or improved vision in 39% of eyes, whereas 12% were eventually enucleated (all of which initially had visual acuity <20/1200). The outcome depended mainly on progression of the underlying vascular disease.

Adult↗
PubMed2006

Dust and noise exposures among farmers in Southland,New Zealand.

This was a cross-sectional survey of the health of farmers in Southland, New Zealand and in a sub-sample, included daily noise and inhalable dust exposure measurements, and a walk through assessment of farm buildings. The median inhalable dust level for arable farmers was 1.7 mg/m(3) with 0.7 mg/m(3) for sheep farmers (NZ standard 10 mg/m(3)). Total daily noise exposure levels were 86.8 dB(A) for sheep farmers, and 85.7 dB(A) for mixed farmers (NZ standard 85 dB[A]). A higher proportion of farmers had low ratings for chemical safety and dust levels in farm buildings compared with other parameters, such as stockhandling or machinery safety. Noise remains an important hazard for NZ farmers, although dust less so, based on inhalable levels. Reducing noise at source is required, as well as greater use of hearing protection. Inhalable dust levels were low due to the nature of farming in NZ where outdoor pastoral farming is the norm.

Agricultural Workers' Diseases↗
PubMed2006

Clinical outcome of older patients with acute coronary syndrome over the last three decades.

OBJECTIVE: To Evaluate the clinical outcome of patients with acute coronary syndrome (ACS) in the Coronary Care Unit (CCU) over three decades in Dunedin, New Zealand. DESIGN: Registry study. SETTING AND PATIENTS: all consecutive patients (n = 3,013) with ACS admitted to the CCU from 1979 to 1981 (n = 966) and from 1989 to 1991 (n = 1470) were included prospectively. Data on ACS patients managed in the CCU in 2001-2002 (n = 577) were obtained via medical chart review. RESULTS: There was a rising proportion of older (> or = 75 years of age) patients with ACS (3.8% in 1979-1981, 15.2% in 1989-1991 and 25.6% in 2001-2002, P < 0.0005). However, we observed a progressive reduction of in-hospital mortality for ACS (10.7, 7.3 and 5.0%, P < 0.005) and for ST-elevation myocardial infarction (STEMI) (18.4, 16.1 and 6.6%, P < 0.005). The progressive fall in mortality rate was also observed amongst older patients, both for ACS (27, 19.2 and 11.5%, P = 0.011) and for STEMI (34.8, 30.9 and 15.4%, P < 0.005). Of concern, only 10% of patients presented within 1 h of symptom onset and 50% within 5 h, and this has not changed over three decades. The variables associated with < 5 h from symptom onset to presentation were men [odds ratio (OR) 1.25, 95% confidence interval (CI) 1.10-1.42, P = 0.001], a history of ischaemic heart disease (OR 1.25, 95% CI 1.09-1.43, P = 0.002) and STEMI (OR 1.41, 95% CI 1.18-1.67, P < 0.0001). Advanced age was not a predictor for late presentation. CONCLUSIONS: Over the past three decades, more old patients were treated in the CCU. However, there was a decline in hospital mortality, particularly for STEMI. Further efforts are required to decrease the time to presentation.

Adult↗
PubMed2006

Lessons learned from large-scale comparative dental analysis following the South Asian tsunami of 2004.

The aim of this study was to examine the quality of the ante-(AM) and postmortem (PM) dental data that were submitted for entry into the PLASS data system in Phuket, Thailand, following the Boxing Day (December 26) Tsunami, 2004. The investigators were two forensic odontologists who were part of the New Zealand Disaster Victim Identification team that worked at Wat Yang Yao morgue and at the Information Management Center in Phuket. Our findings underline the usefulness of dental data in human identification, but point to a number of significant sources of error. Of the 78 PM records received, only 68% of radiographs and 49% of photos confirmed the accompanying dental charting. This underlines the value, particularly of photographs of the dental arches, in quality control. It also points to a large error component, which may have been due to inexperience of the operators, fatigue, poor conditions in the temporary morgue, or the problem of tooth-colored fillings. Of the 106 AM records received, 62% were of unacceptable quality and 64% were either not accompanied by radiographs or had poor quality radiographs. These results indicate that AM data collection ideally needs to be collated and checked by a forensically trained dentist(s) in the country of origin.

Dental Records↗
PubMed2006

Learning in oral biology: a comparison between deep and surface approaches.

It has been suggested that students approach their learning in at least two qualitatively different ways. In the surface approach, students see tasks as being imposed, for which they develop coping strategies focused on reproduction of essentials and memorising information for assessment rather than for understanding. In the deep approach, students seek to understand ideas to allow them to relate and integrate knowledge from other parts of their study and thereby develop conceptual frameworks from which they can derive solutions to novel problems. To these two approaches, a third, achieving approach, is often added, in which students aim to obtain the highest grades, whether or not they grasp the learning material. In this study we used a subject-specified version of Biggs' Study Process Questionnaire to obtain data about the way dental and dental technology students perceived and approached their learning in oral biology. Questionnaires were distributed to 62 second-year dental students and 23 second-year dental technology students. Within each group the dependent variables examined were deep, surface or achieving approaches to learning. Analysis of these data showed that significant differences between dental and dental technology students centred on their approaches to learning. However, there were no significant differences attributable to gender, country of origin or ethnicity. While dental students, who had a relatively well developed understanding of the nature of their studies in oral biology at the start of their course, adopted deep learning strategies, dental technology students, who had had no prior experience of university education per se, were significantly more surface-orientated.

Achievement↗
PubMed2005

Lumbar segmental instability: a criterion-related validity study of manual therapy assessment.

BACKGROUND: Musculoskeletal physiotherapists routinely assess lumbar segmental motion during the clinical examination of a patient with low back pain. The validity of manual assessment of segmental motion has not, however, been adequately investigated. METHODS: In this prospective, multi-centre, pragmatic, diagnostic validity study, 138 consecutive patients with recurrent or chronic low back pain (R/CLBP) were recruited. Physiotherapists with post-graduate training in manual therapy performed passive accessory intervertebral motion tests (PAIVMs) and passive physiological intervertebral motion tests (PPIVMs). Consenting patients were referred for flexion-extension radiographs. Sagittal angular rotation and sagittal translation of each lumbar spinal motion segment was measured from these radiographs, and compared to a reference range derived from a study of 30 asymptomatic volunteers. Motion beyond two standard deviations from the reference mean was considered diagnostic of rotational lumbar segmental instability (LSI) and translational LSI. Accuracy and validity of the clinical assessments were expressed using sensitivity, specificity, and likelihood ratio statistics with 95% confidence intervals (CI). RESULTS: Only translation LSI was found to be significantly associated with R/CLBP (p < 0.05). PAIVMs were specific for the diagnosis of translation LSI (specificity 89%, CI 83-93%), but showed poor sensitivity (29%, CI 14-50%). A positive test results in a likelihood ratio (LR+) of 2.52 (95% CI 1.15-5.53). Flexion PPIVMs were highly specific for the diagnosis of translation LSI (specificity 99.5%; CI 97-100%), but showed very poor sensitivity (5%; CI 1-22%). Likelihood ratio statistics for flexion PPIVMs were not statistically significant. Extension PPIVMs performed better than flexion PPIVMs, with slightly higher sensitivity (16%; CI 6-38%) resulting in a likelihood ratio for a positive test of 7.1 (95% CI 1.7 to 29.2) for translation LSI. CONCLUSION: This study provides the first evidence reporting the concurrent validity of manual tests for the detection of abnormal sagittal planar motion. PAIVMs and PPIVMs are highly specific, but not sensitive, for the detection of translation LSI. Likelihood ratios resulting from positive test results were only moderate. This research indicates that manual clinical examination procedures have moderate validity for detecting segmental motion abnormality.

Adult↗
PubMed2005

Use of evidence-based management for acute coronary syndrome.

AIMS: This study compared the management of acute coronary syndrome (ACS) for patients admitted to Dunedin Coronary Care with evidence-based recommendations from the American College of Cardiology / American Heart Association in 1999 and 2002 and with management reported in international and local registries. METHODS: All patients with ACS from 2001-2002 were included. RESULTS: Guidelines stated that aspirin, beta-blockers, statins, and ACE-inhibitors/angiotensin-II-blockers are appropriate treatment for acute coronary syndrome. These medications were prescribed respectively in 98%, 80%, 70% and 55% of patients on discharge. In patients with documented dyslipidaemia, Statins was prescribed in 80% on discharge. The use of ACE inhibitors was 73% in patients with impaired left ventricular function, 79% in patients with clinical heart failure and 84% in patients with anterior ST-elevation myocardial infarction (STEMI). For patients with STEMI, 67% received coronary angiography, 50% had PCI and 7% underwent inpatient coronary artery bypass grafting. For Non-ST-elevation myocardial infarction (NSTEMI), the respective numbers were 73%, 38% and 21%. Our use of evidence-based medications was consistent with published guidelines and comparable to results of international registries (CRUSADE, EUROESPIRE II, GRACE) in 2001-2002. CONCLUSION: There is good adherence to the use of evidence-based management for acute coronary syndrome in Dunedin Coronary Care Unit.

Acute Disease↗
PubMed2005

The reporting quality of abstracts of randomised controlled trials submitted to the ICS meeting in Heidelberg.

AIMS: The quality of randomised controlled trials (RCTs) is associated with bias. Thus, reports of RCTs must have enough detail of key elements of quality to enable them to be interpreted properly. This study examines the quality of abstracts of RCTs reported at the ICS meeting in Heidelberg in 2002, using the CONSORT statement as the gold standard. MATERIALS AND METHODS: All of the abstracts accepted for the meeting at Heidelberg were read to identify reports of RCTs. Copies of these were printed and examined to see whether they complied with the 22 items in the CONSORT statement. As these were all abstracts the first CONSORT item was changed so that to comply the title had to say it was a randomised trial. Each item was scored as not met, partially met, met. RESULTS: Fifty-three reports of RCTs were found. Five of these were podium presentations, 14 discussion posters, and 34 non-discussion posters. Most reports did not comply with many of the items in the CONSORT statement, lacking particularly in technical details of the methods (only one study clearly reported hidden allocation to groups), and how the results were presented (only two studies fully reported results). Only 2/53 of the abstracts complied fully with more than 10 of the items, and 30/53 did not comply at all with 10 or more. CONCLUSIONS: The quality of reporting of studies at ICS is so poor that it is difficult to interpret the results. Reporting was particularly poor on the details of the randomisation and the numeric results.

Abstracting and Indexing↗
PubMed2005

A "new and improved" EQ-5D valuation questionnaire? Results from a pilot study.

Notwithstanding its widespread use, the standard questionnaire used to elicit visual analogue scale valuations for EQ-5D states is well known to suffer from problems with missing values (particularly for the state "dead") and logical inconsistencies. This contribution reports on efforts to redesign the questionnaire to overcome these problems and the results from its use in a pilot study. The redesigned questionnaire asks respondents to provide a numerical score for each state (instead of drawing lines to a visual analogue scale) and employs a new method for valuing "dead". A pilot study was undertaken to gauge the effects of these innovations, over and above other cosmetic changes to the questionnaire. The redesigned questionnaire was found to result in fewer missing values, fewer exclusions and fewer logical inconsistencies. Mean re-scaled values for the health states remained virtually identical. The results suggest that scoring is a better way of eliciting self-completed valuations than scaling.

Adolescent↗
PubMed2005

Otago Glaucoma Surgery Outcome Study: follow-up of young patients who underwent Molteno implant surgery.

OBJECTIVE: To provide data on the results of patients with nonneovascular juvenile glaucoma who had Molteno implant surgery in the province of Otago, New Zealand. DESIGN: Prospective noncomparative case series. PARTICIPANTS: Fifty-five operations in 52 eyes of 45 patients with nonneovascular juvenile glaucoma who had Molteno implant surgery between the ages of 9 and 49 years from 1976 to 2003 at Dunedin Hospital and were observed for a mean of 12.2 years (range, 0.1-25). INTERVENTION: Insertion of a Molteno implant. MAIN OUTCOME MEASURES: Intraocular pressure (IOP) and visual acuity (VA). RESULTS: Insertion of a Molteno implant controlled IOP at < or =21 mmHg with probabilities of 0.89 (95% confidence interval [CI], 0.81-0.97) at both 1 and 2 years and 0.85 (95% CI, 0.75-0.95), 0.78 (95% CI, 0.66-0.90), and 0.71 (95% CI, 0.58-0.85) at 5, 10, and 15 years, respectively. Mean VA was 20/100 preoperatively; improved to 20/60 at 1 year; and stabilized at 20/120 at 5, 10, and 15 years postoperatively. Twenty-nine eyes had their preoperative VA maintained or improved at final follow-up, and the VAs of 17 eyes deteriorated but were at least light perception at final follow-up. CONCLUSION: The use of Molteno implants in cases of nonneovascular juvenile glaucoma controlled IOP with a probability of 0.71 15 years postoperatively, whereas 53% maintained or improved their vision from their preoperative VA at final follow-up.

Adolescent↗