Hospitalizations for pandemic (H1N1) 2009 among Maori and Pacific Islanders, New Zealand.

Community transmission of influenza A pandemic (H1N1) 2009 was followed by high rates of hospital admissions in the Wellington region of New Zealand, particularly among Maori and Pacific Islanders. These findings may help health authorities anticipate the effects of pandemic (H1N1) 2009 in other communities.

Prescriber compliance with renal function monitoring in patients taking dabigatran (Pradaxa).

AIM: To assess whether patients prescribed dabigatran had their renal function monitored in accordance with published guidelines. METHODS: We recruited patients from Hutt Hospital and two large primary care practices if they were prescribed dabigatran between July 2011 and April 2012. We assessed patients prescribed dabigatran for more than a year to ascertain whether renal function was monitored at least annually, in keeping with guidelines. RESULTS: All patients had baseline renal function testing. At baseline, 42 (60%) had an eGFR (estimated Glomerular Filtration Rate) over 60mL/min/1.73m2 and 28 (40%) had eGFR between 30-60mL/min/1.73m2. Median follow up was 46 months. Whilst taking dabigatran, 44 of the 70 patients (63%) had at least annual renal function. CONCLUSIONS: Over one-third of patients taking dabigatran for over a year did not have their renal function monitored in keeping with current guidelines, potentially leading to an increased risk of bleeding. We suggest there is a need for an automated reminder to prompt annual renal function testing.

Chest tube drainage of pleural effusions--an audit of current practice and complications at Hutt Hospital.

AIMS: The aims of the study were to review small-bore chest tube insertion practices for drainage of pleural fluid at Hutt Valley District Health Board (HVDHB), to assess complications, and compare the findings with international data. METHODS: Retrospective analysis of clinical records was completed on all chest tube insertions for drainage of pleural fluid at HVDHB from December 2008 to November 2009. Descriptive statistics were used to present demographics and tube-associated complications. Comparison was made to available similar international data. RESULTS: Small-bore tubes comprised 59/65 (91%) chest tube insertions and 23/25 (92%) complications. Available comparative data was limited. Ultrasound was used in 36% of insertions. Nearly half of chest drains placed for empyema required subsequent cardiothoracic surgical intervention. CONCLUSIONS: Chest drain complication rates at HVDHB were comparable to those seen internationally. Referral rates to cardiothoracic surgery for empyema were within described ranges. The importance of procedural training for junior medical staff, optimising safety of drain insertions with ultrasound guidance, and clear clinical governance for chest tube insertions are important in minimising harm from this procedure. Specialist societies need to take a leadership in providing guidance on chest drain insertions to secondary and tertiary hospitals in Australia and New Zealand.

Clinical and epidemiological characteristics of the hospitalised patients due to pandemic H1N1 2009 viral infection: experience at Hutt Hospital, New Zealand.

AIM: Pandemic H1N1 2009 virus (H1N1 2009) community transmission was first noted in New Zealand in the Wellington region. There is limited information of clinical and epidemiological characteristics of H1N1 2009 patients from USA and Mexico but no published reports available in New Zealand. We studied clinical and epidemiological features of patients with H1N1 2009 infection admitted to Hutt Valley Hospital. METHODS: We collected and analysed clinical and epidemiological information of all adult inpatient admitted to Hutt Hospital with confirmed H1N1 2009 infection over 5- week period from 17 June 2009 to 22 July 2009. RESULTS: There were 54 adult inpatient admissions with confirmed H1N1 2009 infection during the study period. Epidemic curve suggest rapid increase in number of cases during first 2 weeks with abrupt cessation of new cases by mid-July. The majority of the patients were female (74%) and belonged to Maori (38%) and Pacific (25%) races. Most of the patients were below 50 years of age (76%) but mean age of the cases increased weekly with progression of outbreak. The majority had comorbidities (78%) including asthma, obesity, and diabetes. 38% were smokers. 20% had diarrhoea and vomiting. 48% of the patient had multi-lobar infiltrates on chest X-ray. Nine patients received ICU/HDU (intensive care unit/high dependency unit) care and all of these patients had significant comorbidities. There were no deaths during this period. CONCLUSIONS: H1N1 2009 infection predominantly affected young Maori and Pacific women with relative sparing of the elderly. Patient who received ICU/HDU care had significant comorbidities. This study provides a reliable account of clinical and epidemiological features of H1N1 2009 infection in a medium-size hospital in New Zealand.