Nolan Cullen (flyatom42)

Rural hospitals in New Zealand face difficult workforce challenges to maintain services and quality outcomes. Ashburton Hospital has undergone a 10-year transition from a secondary specialist to a rural generalist medical model of care. Current senior medical staff (rural hospital medicine fellows) here explore their experience of the process and outcomes of this transition. Key drivers for change included commitment and support from management, senior medical staff and the local community, the new rural hospital medicine qualification and a core group of doctors willing to train in it. Nafamostat research buy Challenges included the need to adapt rapidly to even a single doctor's departure, initial lack of credibility of the new qualification, and choice between a single or two-tier system of medical rostering. While acute and elective surgical services were lost, acute medical and rehabilitation services were maintained or increased. Presentations to the acute assessment unit, including high acuity cases, have more than doubled over the period described. Workforce stability has been enhanced and commitment to training contributes to future workforce sustainability. Long-term shared strategic commitment to transition was a key factor in successfully traversing challenges faced. Rural and provincial communities should consider rural generalism as a medical model to sustain and further develop their local hospital services.AIM Obtain an overview of the current sleep habits and sleep hygiene practices in a group of intermediate-aged students, and establish whether these students achieve adequate sleep according to the New Zealand education and health guidelines. METHODS A standardised sleep health questionnaire and seven-day sleep diary were completed by 163 participants (aged 11-13; 62% female) from a cross-section of five Christchurch schools. RESULTS In this group, 71% of students reported 9-11 hours of sleep per night (averaged over seven days). Total sleep time was independent of gender and the day of the week. Bedtimes and wake-times were earlier from Monday-Thursday compared to the weekend (p less then 0.0001). Fifty-nine percent of students used a device in the hour before bed. Pre-bedtime device users were more likely to achieve less sleep than non-device users (p less then 0.001). The majority of students (66%) did not choose their bedtime. CONCLUSIONS In this group of students, the majority achieved a sleep duration within the advised Ministry of Education and Sleep Health Foundation guidelines, despite non-recommended sleep hygiene practices in the pre-bed routine. Parental guidance, with respect to bed times and reduction in device usage before sleep are two factors that could be employed to improve sleep in this group.AIM To evaluate the practice of inherited thrombophilia testing at Waikato Hospital Laboratory, benchmarked against the British Society of Haematology (BSH) guidelines with the plan to reduce unnecessary testing. METHODS We retrospectively reviewed data on all inherited thrombophilia tests performed in the Waikato Hospital Laboratory during August 2015. We then established a local Choosing Wisely guideline for testing. A clinical and laboratory programme was developed to facilitate the implementation of this guideline. Ordering practices were re-evaluated six months after the implementation of the Choosing Wisely programme. RESULTS Of the 94 requests received in August 2015, only one complied with BSH guidelines. Most abnormal results did not change the clinical management of patients. In the first six months following the implementation of our intervention, there was a significant reduction of tests performed with an estimated savings of $118,000. CONCLUSIONS The majority of inherited thrombophilia tests performed in our laboratory did not comply with BSH guidelines. A multimodal inherited thrombophilia Choosing Wisely programme was successful in reducing unnecessary testing. A laboratory protoco