PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Auckland Hospital”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMed2004

Outpatient Parenteral Antimicrobial Therapy (OPAT): a review of experience at Auckland Hospital.

AIM: To review the Auckland Hospital Outpatient Parenteral Antimicrobial Therapy (OPAT) Service. METHODS: Patients (>15 years of age) were referred to the Service and assessed for suitability for outpatient therapy by an infectious diseases physician and a specialist nurse. Patient demographics, referring service, site of infection, and infecting organism, antimicrobial agent/s and outcomes of treatment including complications were recorded. RESULTS: Over a 20-month period 100 patients were treated with 107 courses of outpatient parenteral antibiotic therapy. Bone and joint infections accounted for close to two thirds (60%) of the referrals; discitis/osteomyelitis (36%), septic arthritis (14%) and infected metalware/prosthetic joint infections (10%). Staphylococcus aureus was the most frequently isolated organism (42%), and in 21% of cases no organism was identified. In general, antibiotics prescribed were narrow spectrum and all but six patients self-administered up to four times daily. Eighty-eight percent of treatment courses resulted in a cure. Complications related to therapy occurred in 35% of patients. CONCLUSIONS: We have found that parenteral antibiotic therapy can be administered safely and successfully in an outpatient setting despite relatively frequent dosing intervals. The majority of complications were minor, and 88% of patients were cured.

Adult↗
PubMed2000

An audit of phase II cardiac rehabilitation at Auckland hospital.

AIM: To audit Phase II cardiac rehabilitation services available to patients admitted to Auckland Hospital in order to assess patient uptake and to identify problems with patient recruitment to the service. METHODS: We performed a retrospective review from 1/8/ 97 to 30/9/97 of all patients admitted to the coronary care/ cardiology departments in Auckland Hospital. RESULTS: There were 289 patient admissions in this two month period, of which 22 (8%) were readmissions. 154 (54%) were admissions with provisional diagnoses of chest pain, of whom eight were readmissions. A total of 113 (39%) patients were felt to be suitable for the rehabilitation programme, of whom 50 (44%) attended one or more sessions and 22 (19%) completed the six week programme. 63 (56%) of the eligible patients did not attend any session. Reasons for non-attendance included the distance to be travelled, availability of transport and problems associated with taking time off work. A major finding of the audit was that the systems currently in place to follow patients are inadequate to allow formal audit and evaluation of the rehabilitation service. CONCLUSIONS: Although a reasonable rehabilitation service exists for Auckland Hospital patients, less than half of suitable patients attend a single session. There is a need for better collection and recording of patient data in order to facilitate the development of evaluation and audit tools.

Aged↗
PubMed2002

Co-morbidity and health outcomes in three Auckland hospitals.

AIMS: To establish the burden of co-morbid disease using the Charlson Index among hospital inpatients and its relationship to key health outcomes. METHODS: An initial screen was carried out on 1575 medical records selected by systematic list sample from admissions for 1995 in three public hospitals in the Auckland region. In the course of the administration of the instrument, screeners were required to record the occurrence of co-morbid disease using the Charlson Index. RESULTS: A third of patients had co-morbid disease, of which chronic pulmonary disease and congestive heart failure were the most frequently recorded. While the Charlson Index was associated with age of patient, length of stay, inpatient mortality, and adverse event status, the simple presence or absence of co-morbidity was as an effective predictor as the extended index. Co-morbidity was more likely to be recorded for Maori, for patients from deprived areas, and for circulatory or respiratory diagnoses. Specific co-morbid conditions were predictive of health outcomes. CONCLUSIONS: Levels of co-morbid disease established for patients using the Charlson Index in three Auckland public hospitals are similar to those recorded internationally. Co-morbidity is predictive of key health outcomes that are of clinical and managerial significance. Controlling for co-morbidity will be important in making comparisons of the quality of care.

Adolescent↗
PubMed1996

Percutaneous endoscopic gastronomy feeding tubes: a retrospective review at Auckland Hospital 1993-4.

AIMS: A retrospective review of patients being treated by percutaneous endoscopic gastrostomy (PEG) at Auckland Hospital from 1993-4 was undertaken in order to determine patient characteristics, clinical outcome and to compare these results with published series. METHODS: The case notes of all patients having PEGs performed in the Auckland Hospital gastroenterology unit during the defined period were reviewed. Demographic details, indications, morbidity and mortality data were obtained. Data were supplemented with information obtained from the general practitioner. RESULTS: Fifty procedures (18 in 1993, 32 in 1994) were performed on 41 patients (29 male 12 female), with a mean age of 61 years. Neurological disorders represented the most common clinical indication (25) followed by head and neck malignancy (9). Three patients (7) died within 30 days of the procedure and 13 (32) had early complications (less than 30 days) with four (10) having late complications. Significant pain requiring narcotics occurred in 18. CONCLUSIONS: Results were in general comparable to published series apart from a higher early complication rate (32% vs 16%). Pain may be significant post procedure and should be anticipated. The increasing use of this procedure in our hospital reflects its acceptability to patients, relatives and staff as a means of providing nutritional support to the patient with disorders of swallowing.

Adolescent↗
PubMed2006

Prescribing oxygen therapy. An audit of oxygen prescribing practices on medical wards at North Shore Hospital, Auckland, New Zealand.

AIM: To assess the frequency and accuracy of inpatient oxygen prescription at North Shore Hospital, Auckland. METHOD: Between 14 April 2005 and 14 May 2005, 100 medical inpatients receiving oxygen therapy were randomly selected for chart review. For each patient, the clinical diagnosis, oxygen prescription (if present), and initial medical plan were analysed in conjunction with the oxygen flow rate and oxygen saturations (as documented in the observation chart). RESULTS: Only 8% of patients receiving oxygen had it prescribed in their medication chart. The majority (75%) of oxygen prescriptions were inadequate. CONCLUSION: Current rates of oxygen prescription on medical wards at North Shore Hospital, Auckland, are unsatisfactory. This poor oxygen prescription rate carries serious potential consequences.

Blood Gas Analysis↗
PubMed2002

Endoscopic injection therapy for non-variceal upper gastrointestinal bleeding at Auckland Hospital.

AIM: The aim of this study was to audit the efficacy of endoscopic injection therapy for non-variceal upper gastrointestinal (GI) bleeding at Auckland Hospital. METHODS: The medical records of 183 patients who had undergone endoscopic injection of adrenaline for non-variceal upper GI bleeding at Auckland Hospital between November 1996 and May 1999 were reviewed. RESULTS: Primary haemostasis was achieved in 177 (96.7%) patients and six (3.3%) patients had early surgery due to failure of injection therapy. The overall rate of rebleeding was 18.6%. The rate of rebleeding according to the stigmata seen at the time of endoscopy was 36.8% for patients showing spurting vessel; 24% for active ooze; 18.2% for visible vessel; and 3.2% for adherent clot. Active spurting vessels seen on endoscopy were associated with higher risk of repeat injection (p <0.01) and death (p <0.001). Sixteen (9%) patients had repeat injection. Haemostasis was achieved in all, and no deaths or surgical interventions were observed in this subgroup. CONCLUSIONS: Endoscopic injection therapy is an effective, simple and cheap first-line therapy for non-variceal upper GI bleeding. The repeat injection also appears to be an effective treatment for patients rebleeding after the initial injection therapy.

Aged↗
PubMed1999

Management of stroke in Auckland Hospital in 1996.

AIMS: To review the management of stroke in Auckland Hospital; compare current management with practice in Auckland in 1991/92; and determine how many patients may be suitable for treatment with aspirin or tissue plasminogen activator (t-PA). METHODS: Retrospective review of case notes for all patients over the age of 15 years presenting during four months in 1996 with symptoms and signs of an acute stroke. Subarachnoid haemorrhages were excluded. RESULTS: There were 184 stroke events (135 ischaemic strokes, 26 intracerebral haemorrhages, 23 unspecified strokes) in 179 patients. The time between the onset of symptoms and arrival in hospital was available for 109 patients: the overall median time was three hours, two hours for intracerebral haemorrhages, three hours for ischaemic strokes, four hours for unspecified strokes. Most patients (78%) were admitted to a general medical ward. Only 10% of the patients managed on a non-neurological ward were referred to a neurologist. Computed tomography (CT) was obtained in 88% of the patients. The median time from the onset of symptoms to CT was 19 hours (11 hours for intracerebral haemorrhages, 21 hours for ischaemic strokes). Only 11 patients (10%) were scanned within three hours of the onset of symptoms. Of the 135 patients who had an ischaemic stroke, 36% were treated with aspirin and 6% with heparin in the first 48 hours. Thirty-two patients (17%) died in hospital, 87 (47%) returned home, 37 (20%) were transferred to a rest home or private hospital and 28 (15%) were transferred to other places. CONCLUSIONS: Compared with 1991, the rate of CT scanning after a stroke increased from 42% to 88%. At present, no more than 5% of all patients presenting with a stroke are suitable for consideration of treatment with t-PA. Routine treatment with aspirin in the first 48 hours could be achieved without other major changes in management.

Acute Disease↗
PubMed1983

The Auckland Hospital ethical committee 1977-1981.

The experience of the Auckland Hospital ethical committee during the last five years is reviewed. The committee has dealt with an average of 3.6 new applications per month. The research proposals have been classified according to their major thrust. Forty-five point five percent were drug trials, 12.8% were studies of normal and abnormal physiology and metabolism, 12.3% involved the evaluation of new non-drug therapeutic techniques or programmes, 10.1% were epidemiological and the remainder were psychosocial investigations, studies of drug metabolism and turnover, audit and review, or miscellaneous in nature. The majority of applications (60.4%) were approved unaltered or with only very minor amendments at their first consideration. Thirty-six point four percent were approved subject to the imposition of certain conditions or after revision, and 3.2% were either not approved at all or were withdrawn. Major ethical issues which attracted the committee's attention are briefly outlined and its reaction reported.

Ethics, Medical↗
PubMed1984

Paediatric admissions to Auckland Hospital for asthma from 1970-1980.

Paediatric admissions to Auckland Hospital were examined for 1970 to 1980. The number of individual patients admitted for asthma each year increased significantly over the study period. The rate was higher in the 0-4 year age group than in the 5-14 year age group and was higher in Maori and Pacific Islander children than in Europeans. The male to female ratio was 1.4:1 over the period. The readmission rate increased between 1972 and 1980 and was higher for Polynesians than Europeans although there was no difference in the readmission rates of the 0-4 year age group compared to that of the 5-14 year age group. The mean length of hospital stay decreased significantly, but was longer in Polynesians than in Europeans.

Adolescent↗
PubMed1998

Diabetic ketoacidosis in adults at Auckland Hospital, 1988-1996.

BACKGROUND: Diabetic ketoacidosis (DKA) is associated with significant morbidity and mortality. Recent evidence suggests that patients with both type 1 and type 2 diabetes can develop DKA. AIM: To review the experience in managing patients admitted to Auckland Hospital with DKA over an eight year period. METHODS: A retrospective chart review was undertaken to identify patients with a discharge code of DKA admitted to Auckland Hospital between May 1988 and October 1996. RESULTS: One hundred and twenty-five patients were identified who met the defined criteria for DKA. The in-patient mortality for the group was 2.4%. Thirteen patients (10.4%) probably had type 2 diabetes. Thirty-eight (30.4%) patients were admitted to the Department of Critical Care Medicine (DCCM)--these patients had a significantly lower systolic blood pressure and arterial pH, together with a significantly higher admission blood glucose and longer duration of insulin infusion than those not admitted to DCCM. Following their index admission 25% of patients were readmitted to hospital with DKA during the study period. Errors in insulin self-administration that contributed to admission to hospital with DKA were identified in 61% of the patients with known diabetes. CONCLUSIONS: Patients with DKA in this study spent about a week in hospital and a significant proportion were admitted to the DCCM. In spite of this the overall mortality was low. Many of these patients were readmitted to hospital with DKA. A small number of patients with DKA may have type 2 diabetes and may not need long term insulin therapy. More effort on patient education regarding insulin use with illness, may prevent admission to hospital with DKA.

Adult↗
PubMed2004

The Auckland Hospital Ethics Committee: the first 7 years.

We describe the establishment and development of the Clinical Ethics Advisory Group (CEAG) at Auckland Hospital. The CEAG provides a case-consultation service for clinicians and managers and on request advises on policies and guidelines. Relatively few cases have been referred for consultation despite the fact that 82% of doctors and 98% of nurses see a role for the CEAG in helping to resolve dilemmas in clinical practice. Most clinicians (80%) who have consulted the CEAG have valued the opinions they were given. The majority of doctors (81%) and nurses (76%) indicated that they would value further education in ethics. Based on our experience and a review of the literature, we recommend that all healthcare workers should have access to ethical expertise.

Attitude of Health Personnel↗
PubMed1977

Auckland hospital ethical committee: the first three years.

A committee responsible for the ethical surveillance of research involving human subjects has been in existence at the Auckland Hospital for over three years. Guidelines for clinical investigators have been published and a form of application for approval of research projects designed. Major problems grappled with in 121 research projects are outlined. The need for such ethical surveillance appears to have been established beyond reasonable doubt.

Ethical Review↗
PubMed1991

Home parenteral nutrition at Auckland Hospital.

This paper reports the results of home parenteral nutrition (HPN) from Auckland Hospital. In the last two and a half years, six patients have gone home from hospital on HPN. Four are still on it, after periods of from one to 30 months. There has been one death and one patient who developed catheter sepsis. Quality of life on HPN has in general been very good. Body composition studies performed on these patients have shown that a normal body composition can be maintained while on HPN.

Adult↗
PubMed1977

Accident and emergency services at Auckland hospital.

This is an investigation of the role that the accident and emergency department of the Auckland Hospital plays in the provision of medical care in the Auckland area. It is demonstrated that a significant part of the work that is done in that department could equally well be performed by general practitioners and that there is a need for further education of the public concerning the delivery of health care.

Adolescent↗
PubMed1995

Treatment of macroprolactinomas at Auckland Hospital 1975-91.

AIM: A retrospective review of management of patients with macroprolactinomas at Auckland Hospital 1974-93 to determine the efficacy of treatment. METHODS: Patients were identified from departmental patient disease index records and treatment outcome assessed. RESULTS: Thirty four patients (24 male, 10 female) were identified. The mean serum prolactin was 89,700mIU/L. Visual field defects were present in 20 and 24 were hypogonadal at presentation. Initial treatment was with bromocriptine (n = 24) or surgery (n = 7). Twelve medically treated patients were subsequently treated surgically (3 because of pituitary haemorrhage or infarction, nine because of slow or absent response to medication). Visual field improvement was similar in the medical and surgical groups and major treatment complications occurred in 3 of the medical and 3 of the surgical patients. Radiotherapy was given to 25 patients. Overall treatment responses over a mean follow up of 4 years were similar in surgically and medically treated patients. Overall only a third of patients had a normal serum prolactin at last follow up, pregnancy had occurred in 20% of potentially fertile patients and 35% were hypopituitary. CONCLUSIONS: Bromocriptine is a satisfactory first line treatment for macroprolactinomas, but although treatment reduces tumour size and reverses field defects in 75% of cases only one third of patients achieve a normal prolactin over medium term follow up.

Adolescent↗
PubMed2004

Changes in stroke care at Auckland Hospital between 1996 and 2001.

AIMS: In 1996, we performed a descriptive audit of stroke care in Auckland Hospital. Since then, a mobile stroke team has been established. We have repeated the 1996 audit to assess changes in stroke management. METHODS: From 1 June to 30 September 2001, information was prospectively recorded for all patients with stroke. RESULTS: There were 177 strokes in 175 patients (92 men, mean age 70.9, standard deviation [SD] 14.9 years). Ninety-seven percent of patients had cerebral imaging (median 4.5 hours; interquartile range [IQR] 2.7-11.6). Acute aspirin was given to 78% of patients in 2001 and 40% in 1996 (p <0.001). Twenty-four percent of patients were kept 'nil by mouth' for at least 24 hours (46% in 1996, p <0.001). At discharge, 73% of patients were taking antiplatelet or anticoagulant therapy (61% in 1996, p <0.001). Only 50% of the patients with elevated discharge blood pressures were taking antihypertensives. There had been a reduction in the mean length of hospital stay to 16 days (21 days in 1996) but no significant change in mortality (14% compared with 17% in 1996). CONCLUSION: A stroke service may increase the attention to the 'processes' of stroke care and use of therapies, which are shown to be of benefit in randomised controlled trials.

Aged↗
PubMed1990

The spectrum of systemic candidiasis at Auckland Hospital.

Systemic candidiasis is uncommon. We reviewed our experience with this disease from the infectious disease unit, Auckland Hospital, between 1982 and 1988, because many of these patients are referred to us. We then selected 11 of them to highlight particular presentations, diagnostic or management issues. We included both compromised and noncompromised patients from medical and surgical services. Candida albicans was the most common cause, but we also saw patients infected with C glabrata, C parapsilosis, and C tropicalis and present them to exemplify their different clinical presentations. Demonstrable fungaemia is uncommon in patients with systemic candidiasis, serological techniques are both insensitive and nonspecific and patients are often too ill from underlying disease to allow for invasive diagnostic procedures. Thus diagnosis is often difficult. Parenteral amphotericin B with or without 5-fluorocytosine is still the main antifungal treatment. Triazole antifungals may change that in the future. Systemic candidiasis retains a high mortality: careful individualised management of patients may improve mortality and morbidity.

Adult↗