Review of Maori equity in surgical trainee selection.

BACKGROUND: The Royal Australasian College of Surgeons (RACS) aims to achieve Maori health equity and cultural safety within the surgical workforce. The RACS Maori Health Strategy and Action Plans encourage Surgical Education and Training (SET) selection criteria that recognizes and credit applicants who identify as Maori or demonstrate competence in Maori health issues. This study investigates the current SET selection criteria for Maori entering surgical specialties. METHODS: The selection criteria for each surgical speciality for the proposed 2024 intake were examined through a documentary analysis. Criteria were reviewed for applicability to Maori identification and/or cultural competency. RESULTS: Criteria related to Maori identification and/or cultural competency make up 6%, 2%, and 1.5% of Otolaryngology and Head and Neck, General, and Vascular Surgery total SET selection score respectively. Criteria related to Maori identification and/or cultural competency make up 9% and 0.1% of Orthopaedic and Plastics and Reconstructive Surgery ranking scores for interview eligibility respectively. Cardiothoracic Surgery, Paediatric Surgery, Neurosurgery and Urology specialties do not incorporate any criteria appertaining to Maori. Allocation of research-related points determined by authorship may disincentivize Maori trainees. CONCLUSIONS: Some surgical specialties fail to recognize or credit Maori identification and cultural competency in SET selection criteria. There is a need for regular auditing to ensure SET criteria align with the RACS aspirations for Maori health equity and cultural safety within the surgical workforce.

The Surgical Sisterhood - The Experiences of wahine Maori and Pasifika Aspiring Surgeons.

The establishment of a culturally diverse surgical workforce, largely on the basis of gender, has been highly promoted in Australasia in the last decade. Despite this, discussions of gender diversity in surgery have largely excluded Indigenous women. This study presents the experiences of wahine Maori and Pasifika doctors in Aotearoa, who formed a surgical sisterhood to support them towards applying for advanced surgical training. Utilising mana wahine and Masi methodologies, semi-structured interpersonal interviews were undertaken with five wahine who formed the surgical sisterhood. Following transcription and analysis of all interviews, four key themes were identified. These were mana wahine, unity, our why and change on the horizon. These themes illustrate the complex and varied experiences of wahine Maori and Pasifika and how they have navigated their surgical pathways amidst multiple layers of discrimination towards being in a position to apply for advanced surgical training.

The accuracy of self-report logbooks of adherence to prescribed home-based exercise in Parkinson's disease.

PURPOSE: This study compared self-report logbooks of exercise performance to objective measures of performance to determine the accuracy of and patterns of misreporting in self-report logbooks in people with Parkinson's disease. MATERIALS AND METHODS: Fifteen participants from the intervention arm of a randomized control trial were prescribed a minimally supervised, 12-week, home-based upper limb exergame program (ACTRN 12614001048673). The exergame system provided an objective electronic measure of adherence for comparison with self-report logbooks. RESULTS: Logbooks showed excellent to good accuracy of overall reported adherence to prescribed sessions (Intraclass correlation (ICC) = 0.83) and games (ICC 0.71). Logbooks were also a good to fair representation of weekly adherence across participants for both sessions (ICC 0.66) and games (ICC 0.56). Individual participant ICCs ranged from minimal to perfect agreement between logbooks and electronic records (ICC sessions range: -0.02 to 1; games range: -0.24 to 0.99). The pattern of logbook reporting suggested some participants were biasing entries to match prescribed exercise. CONCLUSIONS: Self-report logbooks may provide an accurate measure of overall adherence. However, the accuracy of individual logbooks was highly variable indicating caution is needed in using self-report measures to assess individual adherence in intervention studies and for clinical decision making. Clinical Trial Registration: Registered in Australia and New Zealand Clinical Trials Registry (https://www.anzctr.org.au/): Registration number: ACTRN12614001048673.Implications for rehabilitationAdherence to prescribed unsupervised exercise is usually self-reported.Self-reported logbooks gave a good to excellent indication of exercise adherence overall when compared to electronically captured records for a group of participants with mild to moderate Parkinson's disease.There were high levels of variability in the accuracy of individual logbooks with a tendency to record prescribed rather than actual exercise.Logbooks may be accurate to monitor group adherence, but caution is required when using them to assess an individual's adherence to an exercise prescription.

Home-based step training using videogame technology in people with Parkinson's disease: a single-blinded randomised controlled trial.

OBJECTIVES: To determine whether 12-week home-based exergame step training can improve stepping performance, gait and complementary physical and neuropsychological measures associated with falls in Parkinson's disease. DESIGN: A single-blinded randomised controlled trial. SETTING: Community (experimental intervention), university laboratory (outcome measures). SUBJECTS: Sixty community-dwelling people with Parkinson's disease. INTERVENTIONS: Home-based step training using videogame technology. MAIN MEASURES: The primary outcomes were the choice stepping reaction time test and Functional Gait Assessment. Secondary outcomes included physical and neuropsychological measures associated with falls in Parkinson's disease, number of falls over six months and self-reported mobility and balance. RESULTS: Post intervention, there were no differences between the intervention ( n = 28) and control ( n = 25) groups in the primary or secondary outcomes except for the Timed Up and Go test, where there was a significant difference in favour of the control group ( P = 0.02). Intervention participants reported mobility improvement, whereas control participants reported mobility deterioration-between-group difference on an 11-point scale = 0.9 (95% confidence interval: -1.8 to -0.1, P = 0.03). Interaction effects between intervention and disease severity on physical function measures were observed ( P = 0.01 to P = 0.08) with seemingly positive effects for the low-severity group and potentially negative effects for the high-severity group. CONCLUSION: Overall, home-based exergame step training was not effective in improving the outcomes assessed. However, the improved physical function in the lower disease severity intervention participants as well as the self-reported improved mobility in the intervention group suggest home-based exergame step training may have benefits for some people with Parkinson's disease.

An interactive videogame for arm and hand exercise in people with Parkinson's disease: A randomized controlled trial.

INTRODUCTION: People with Parkinson's disease (PD) have difficulty performing upper extremity (UE) activities. The aim of this study was to investigate if exergames targeting the UE improve arm and hand activities and impairments and to establish the acceptability and feasibility of these games in people with PD. METHODS: Two tablet-based exergames were developed which were controlled with finger movements or unimanual whole arm movements. Participants with PD were randomized to an exergame (n = 19) or control (n = 19) group. The exergame group performed UE exergames at home, 3 times per week for 12 weeks. The primary outcome measure was the nine hole peg test. Secondary outcomes included measures of UE activities and impairments, including the tapping test [speed (taps/60s), and error (weighted error score/speed)]. RESULTS: There were no between group differences in the nine hole peg test, or in any secondary outcome measures except for the tapping test. Horizontal tapping test results showed that exergame participants improved their speed (mean difference = 10.9 taps/60s, p < 0.001) but increased error (mean difference = 0.03, p = 0.03) compared to the control group. Participants enjoyed the games and improved in their ability to play the games. There were no adverse events. CONCLUSION: The UE exergames were acceptable and safe, but did not translate to improvement in functional activities. It is likely that the requirement of the games resulted in increased movement speed at the detriment of accuracy. The design of exergames should consider task specificity.

Cochlear implantation in mitochondrial deafness due to A7445G mutation.

OBJECTIVE: This study aimed to determine if cochlear implantation (CI) improved speech discrimination in the New Zealand pedigree with the A7445G mitochondrial DNA (mtDNA) mutation and sensorineural hearing loss (SNHL). METHODS: Nine patients had their speech discrimination and pure tone audiograms evaluated. Pre- and post-implant results were compared. Type of CI and patient age at implantation was recorded. RESULTS: Speech discrimination testing shows greatly improved functional hearing after CI in this group of patients. DISCUSSION: Individuals with mtDNA-related SNHL should be identified by screening and offered assessment for CI suitability because functional hearing improves after CI.

Peritonsillar infection in Christchurch 2006-2008: epidemiology and microbiology.

AIM: Peritonsillar infection is a complication of acute tonsillitis. It is common and complications can be life-threatening. This study audits all cases of peritonsillar infection presenting to our unit between 2006 and 2008 in order to determine if the epidemiology, bacteriology and antibiotic sensitivity has changed since previous audits in our unit in 1981-1984 and 1990-1992. METHODS: Retrospective chart review. RESULTS: 213 patients were admitted acutely with peritonsillar infection between January 2006 and December 2008. The average age was 29 years with 30.5% patients in the modal age group of 15-19 years. Male to female ratio was 1.5:1. 54% presented with their first episode. 39% received antibiotics prior to presentation. In two-thirds of cases, the duration of admission was less than 24 hours. Culture results were obtained from 69% of specimens. Cultures mostly contained mixed anaerobic and aerobic bacteria. The most common aerobes were streptococcal species. Organisms were almost uniformly sensitive to penicillin. 21% of patients subsequently underwent tonsillectomy, usually as a delayed procedure. CONCLUSION: Peritonsillar infection is a common complication of tonsillitis and can be life-threatening. The number of cases presenting at Christchurch Hospital has increased disproportionate to the population increase since the previous audits. Culture results demonstrate a preponderance of mixed organisms, which may be pathological. Organisms and their sensitivities have not changed since the previous audits. Infection usually responds favourably to drainage in combination with penicillin as the first-line antimicrobial agent.

Nasal fractures: patient satisfaction following closed reduction.

AIM: Nasal fractures are commonly treated by primary closed reduction. However, studies suggest this produces unacceptable functional and aesthetic results. Many patients require revision surgery. We aimed to assess patient satisfaction following closed reduction of nasal fractures. METHODS: Retrospective chart review of patients with nasal fractures treated by closed reduction at the Wellington Regional Plastic, Maxillofacial and Burns Unit, New Zealand over a 2-year period was undertaken. Digital manipulation under general anaesthetic was performed. Patients were followed-up by telephone with a structured interview. RESULTS: Of 116 consecutive patients, 74 (65%) were successfully contacted. 65 (88%) were satisfied with functional outcome, and 64 (86%) with aesthetic outcome. Of the 34 patients reporting incomplete correction, 12 (35%) would consider revision surgery. CONCLUSION: Patients treated with closed reduction of nasal fracture performed under general anaesthetic with digital manipulation reported high levels of satisfaction with functional and aesthetic outcomes. Revision rate is low.