Biomedical subjects

Stewart Mann

Publications and source records attributed to Stewart Mann.

8 recordsLinked to original sources

PubMed2006

Troponin testing for chest pain in primary healthcare: a survey of its use by general practitioners in New Zealand.

AIM: Serum troponin is now the preferred biochemical marker for myocardial infarction. The aim of this study was to investigate general practitioner (GP) knowledge and use of serum troponin testing in primary healthcare. METHODS: We sent a postal survey about troponin testing to all GPs in the Wellington region (n=299) of New Zealand. RESULTS: Of the 299 surveys sent, 216 replies were received (72%). 54% (n=115) of participants were male and 58% (n=113) in full time practice. 92% were using troponin tests (58% monthly). ECG (79%) and serum troponin (78%) were the tests most commonly used to triage patients with chest pain. GPs had excellent knowledge of false negative scenarios (84% correctly identified false negative if test undertaken within 6 hours) and less knowledge of false positive scenarios (39% answered 'Don't know'). CONCLUSIONS: The majority of GPs use serum troponin tests, and have sufficient knowledge of the test for use in a primary care setting. Most GPs use the tests appropriately, although a small proportion of doctors may defer rapid admission to hospital while waiting for the test result (7%) or manage the patient within general practice (5%) in those patients who have chest pain considered 'possibly' due to myocardial infarction.

Biomarkers↗

PubMed2006

Troponin testing for chest pain in primary healthcare: a New Zealand audit.

AIM: Serum troponin is a widely used biomarker for the diagnosis of myocardial infarction (MI). The aim of this audit was to document the actual clinical circumstances when serum troponin tests are used to assess chest pain in primary healthcare. METHODS: We undertook an audit of general practitioner (GP) serum troponin requests made to community laboratories in the Wellington region over a 5-week period in 2004. RESULTS: 433 tests were ordered by 201 GPs and 10 tests were positive. We faxed 396 questionnaires to identifiable GPs requesting the tests and received 292 replies (74%). The time between initial onset of symptoms and troponin testing was biphasically distributed with peaks at 7-12 hours and 3.5 days. An ECG was performed in less than 50% of the cases. The GP's estimate of the likelihood of their patient's symptoms being due to MI was strongly influenced by both positive and negative test results. Patients were referred acutely to hospital on less than 5% of occasions. CONCLUSIONS: GPs used troponin testing mostly for late presentations some days after chest pain, to 'rule-out' MI. When used acutely, referral for admission occasionally awaited the troponin test result.

Biomarkers↗

PubMed2006

How low can it go? Projecting ischaemic heart disease mortality in New Zealand to 2015.

AIMS: This study aims to identify how ischaemic heart disease (IHD) mortality rates in New Zealand have varied between successive cohorts and time periods. This information is then used to project IHD mortality rates and counts (burdens) out to year 2011-15. METHODS: Age/period/cohort models were constructed (5-year periods and 5-year age groups, generating 10-year overlapping cohorts) using both frequentist and Bayesian methods. Data were available from 1956 for the total population and from 1981 for Maori. The projection period was 2001-5 to 2011-15. Uncertainty was quantified as the Bayesian 90% credible interval. RESULTS: IHD mortality rates for all age by gender groups increased from 1956-60 to peak in 1966-70, then declined by more than 60% to current (1996-2000) levels. However, the decline has been much shallower for Maori. This decline has resulted from increasingly favourable period effects since 1971-75 (less marked for Maori). However, no substantive cohort effects have been seen, at least from the 1891 to the 1951 cohort. Our model suggests that, for the first time, a substantive and unfavourable cohort effect may be emerging among recent birth cohorts. CONCLUSIONS: IHD mortality rates are projected to continue to fall from 2001-05 to 2011-15, albeit more slowly than in the past as the increasing (favourable) period effect is partly offset by an emerging (unfavourable) cohort effect. The result is a relatively small projected decline in absolute IHD mortality burden overall, but an actual increase among Maori.

Adult↗

PubMed2005

Statins and myopathy.

Explore the source record for details and available documents.

Dose-Response Relationship, Drug↗

PubMed2005

Dihydropyridines, felodipine, and PHARMAC.

Calcium antagonists have evolved as useful drugs in the treatment of hypertension and angina. Dihydropyridines are the largest subgroup and various products have been marketed. Safety concerns have largely been allayed by comparative outcome trials but concern remains over short-acting products. In New Zealand, many patients requiring fully subsidised dihydropyridines have had several changes of product imposed due to successive reference pricing and sole-supply arrangements, along with deregistering and reregistering of generic felodipine. Some narrowly avoided a complete loss of access to a suitable low dose of any dihydropyridine. Generic substitution and sole-supply arrangements may make useful savings but can leave the supply of key pharmaceuticals vulnerable and impose significant loss in quality of healthcare from multiple changes in pharmaceutical preparation.

Angina Pectoris↗

PubMed2004

Management of patients admitted with an Acute Coronary Syndrome in New Zealand: results of a comprehensive nationwide audit.

AIMS: To audit all patients presenting to a New Zealand hospital with a myocardial infarction or unstable angina (an acute coronary syndrome [ACS]) over a 14-day period, to assess their number, presentation type and patient management during the hospital admission. METHODS: We formed a group of clinicians to lead the local audit process with one representative for each hospital (n=36) that admitted ACS patients. A comprehensive data form was used to record individual patient information for patients admitted between 0000 hours on 13 May 2002 to 2400 hours on 26 May 2002. RESULTS: 930 patients were admitted with a suspected or definite ACS: 11% with a ST-segment-elevation myocardial infarction (STEMI), 31% with a non-STEMI, 36% with unstable angina pectoris (UAP), and 22% with another cardiac or medical diagnosis. Cardiac investigations were limited: echocardiogram (20%), exercise treadmill test (20%), cardiac angiogram (21%). In-hospital revascularisation rates were low for those patients with a definite presentation with an ACS (STEMI, non-STEMI, UAP, n=721). Percutaneous coronary intervention (PCI) rates were 13%, 8%, and 4%--with coronary artery bypass grafting (CABG) rates being 4%, 3%, and 4% respectively. The use of discharge medications of proven benefit was also generally low (n=695): aspirin (82%), clopidogrel (8%), beta-adrenergic blockers (63%), angiotensin converting enzyme (ACE) inhibitors (43%), and statins (55%). CONCLUSIONS: A collaborative group of clinicians has performed a nationwide audit of acute coronary syndrome patients, which has demonstrated low levels of investigations, evidence-based treatments, and revascularisation. There is a need for a comprehensive national strategy--particularly for continuing audit of the treatment of patients presenting with a suspected or definite acute coronary syndrome to a New Zealand hospital.

Adult↗

PubMed2004

Acute Coronary Syndrome patients in New Zealand receive less invasive management when admitted to hospitals without invasive facilities.

AIM: To compare differences in the presentation and management of acute coronary syndrome (ACS) patients presenting to interventional versus non-interventional New Zealand hospitals. METHODS: We assessed the data collected by the New Zealand Cardiac Society ACS Audit Group over 14 days from each hospital in New Zealand (n=36) that admits ACS patients. Patient management at intervention centres (5 public, 3 private) was compared with non-intervention centres (28 public). Investigations and revascularisation procedures performed on transferred patients were attributed to the referring centre. RESULTS: From 0000 hours on 13 May 2002 to 2400 hours on 26 May 2002, 930 patients were admitted to a New Zealand hospital with a suspected or definite ACS: ST-segment-elevation myocardial infarction [STEMI] (11%), non-STEMI (31%), unstable angina pectoris [UAP] (36%), or another cardiac or medical diagnosis (22%). Patients admitted to a non-intervention centre (n=612) were the same age (median 70 years) with similar risk factors, but were more likely to be Maori (8.2% vs 3.8%, p=0.0063) and were less likely to have a history of prior cardiac angiography (26% vs 28%, p=0.02) or percutaneous coronary intervention [PCI] (9.6% vs 14%, p=0.03) than patients admitted to an intervention centre (n=318). Patients admitted to a non-intervention centre were more likely to have a chest X-ray (88% vs 81%, p<0.0024), as likely to have an exercise treadmill test (20% vs 22%, p=0.39), but less likely to receive an echocardiogram (17% vs 26%, p<0.0005), a cardiac angiogram (17% vs 30%, p<0.0001), or neither a treadmill nor a cardiac angiogram (68% vs 53%, p<0.0001) for cardiac risk assessment. For patients with a definite ACS presentation (STEMI, Non-STEMI, UAP, n=721), PCI was performed less often for patients admitted to non-intervention centres: 3% vs 14% (p<0.0001), although the rate of coronary artery bypass grafting was similar: 3% vs 5% (p=0.16). CONCLUSION: Patients admitted to a hospital without cardiac interventional facilities receive fewer investigations and less revascularisation than patients admitted to Intervention Centres. Hence patients admitted with an acute coronary syndrome in New Zealand receive inequitable management. A comprehensive National strategy is needed to improve access to optimal cardiac care.

Adult↗

PubMedDate not supplied

The evolution of restricted hours of duty for resident medical officers in New Zealand: a personal view.

The New Zealand Health Service had to start adapting to significant restrictions in junior medical staff's hours of work in the mid-1980s. Some consequences of this presage those that will occur in the UK and Europe with the implementation of the European Working Time Directive (EWTD). These naturally include continuity of patient care, changing responsibility and hours of senior medical and administrative staff, some aspects of medical professionalism and training issues. Life does, however, go on.

Clinical Competence↗