A Pragmatic Historical Assessment Tool: A New Systematic Framework for the Collation and Evaluation of Documented Empirical Effectiveness and Safety of Traditional Plant Medicines in the European Materia Medica.

INTRODUCTION: Traditional plant medicines (TPMs) are plant-derived therapeutic products prepared and applied according to longstanding medical customs. Around the world they are widely used in primary and preventative health care. The World Health Organization (WHO) calls in its Traditional Medicine Strategy 2014-2023 for Member States to provide a regulatory framework so that the formal contribution of traditional therapeutics can be advanced in national systems of health care. Evidence of effectiveness and safety is paramount for the regulatory integration of TPMs; however, a presumed lack of such "evidence" is one obstacle for full integration. The consequential health policy question is how to systematically evaluate therapeutic claims relating to herbal remedies when the extant evidence is predominantly based on historical and contemporary clinical usage, i.e., is empiricist in nature. This paper introduces a new method along with several illustrative examples. METHOD: Our research design employs a longitudinal, comparative textual analysis of standard textbooks of the professional European medical literature from the early modern period (1588/1664) onwards to today. It then triangulated these intergenerationally documented clinical observations on two exemplars (Arnica and St. John's Wort) with corresponding listings in multiple qualitative and quantitative sources. A Pragmatic Historical Assessment (PHA) tool was developed and tested as a method to systematically collate the large amount of pharmacological data recorded in these judiciously selected sources. The evidential validity of longstanding professional clinical knowledge could thus be compared with therapeutic indications approved in official and authoritative sources (pharmacopoeias, monographs) and with those supported by contemporary scientific research (randomised-controlled trials [RCTs], experimental research). RESULTS: There was high congruency between therapeutic indications that are based on repeated empirical observations from professional patient care (empirical evidence), those approved in pharmacopoeias and monographs, and modern scientific evidence based on RCTs. The extensive herbal triangulation confirmed parallel records of all main therapeutic indications of the exemplars across all qualitative and quantitative sources over the past 400 years. CONCLUSIONS: Historical clinical medical textbooks and contemporary phytotherapeutic equivalents are the key repository of repeatedly evaluated therapeutic plant knowledge. The professional clinical literature proved to be a reliable and verifiable body of empirical evidence that harmonised with contemporary scientific assessments. The newly developed PHA tool provides a coding framework for the systematic collation and evaluation of empirical data on the effectiveness and safety of TPMs. It is suggested as a feasible and efficient tool to extend evidence typologies that substantiate therapeutic claims for TPMs as part of an evidence-based regulatory framework that formally integrates these medically and culturally important therapeutics.Traditionelle pflanzliche Arzneimittel sind aus Pflanzen gewonnene Heilmittel, die gemäß langjähriger medizinischer Praxis zubereitet und angewendet werden. Weltweit sind sie in der primären und präventiven Gesundheitsversorgung weit verbreitet. Die Weltgesundheitsorganisation (WHO) ruft in ihrer Traditional Medicine Strategy 2014­2023 die Mitgliedstaaten dazu auf, regulatorische Rahmenbedingungen zu schaffen, welche den formellen Beitrag traditioneller Therapeutika in den nationalen Gesundheitssystemen fördern. Der Nachweis von Wirksamkeit und Sicherheit ist von zentraler Bedeutung für die regulatorische Integration traditioneller pflanzlicher Arzneimittel, doch das angebliche Fehlen solcher "Nachweise" ist eine der Hürden für die vollständige Integration. Daraus ergibt sich die gesundheitspolitische Frage, wie man therapeutische Anwendungsgebiete pflanzlicher Heilmittel systematisch evaluieren kann, wenn die vorliegende Evidenz überwiegend auf deren historischer und aktueller klinischen Verwendung beruht, also empirischer Natur ist. In dieser Arbeit wird eine neue Methode mitsamt veranschaulichenden Beispielen vorgestellt.Unser Forschungsansatz beruhte auf einer longitudinalen, vergleichenden Textanalyse von Standard-Lehrwerken der europäischen medizinischen Fachliteratur ausgehend von der frühen Neuzeit (1588/1664) bis heute. Die über Generationen dokumentierten klinischen Beobachtungen wurden anhand von zwei Beispielen (Arnika and Johanniskraut) mit den diesbezüglichen Angaben in unterschiedlichen qualitativen und quantitativen Quellen trianguliert. Ein Pragmatisch­Historisches Auswertungstool (PHA) wurde als Methode entwickelt und getestet, um die großen Mengen der in diesen kritisch ausgewählten Quellen enthaltenen pharmakologischen Daten systematisch zu erfassen. Die Evidenzvalidität des langjährigen klinischen Fachwissens konnte so mit den therapeutischen Anwendungsgebieten verglichen werden, die in offiziellen und autoritativen Quellen (Pharmakopöen, Monografien) zugelassen sind, sowie mit denjenigen, die durch zeitgenössische wissenschaftliche Forschung gestützt werden (randomisierte kontrollierte Studien [RCTs], experimentelle Forschung).Es bestand ein hohes Maß an Kongruenz zwischen den therapeutischen Anwendungsgebieten, welche auf wiederholte empirische Beobachtung aus der professionellen Patientenversorgung beruhen (empirische Evidenz), den zugelassenen Indikationen in Pharmakopöen und Monographien sowie der aktuellen wissenschaftlichen Evidenz basierend auf klinischen Studien. Die umfassende pflanzenbezogene Triangulation bestätigte parallele Aufzeichnungen aller wesentlichen Anwendungsgebiete der untersuchten Beispiele in allen qualitativen und quantitativen Quellen über die letzten 400 Jahre hinweg.Historische Lehrbücher für klinische Medizin und zeitgenössische phytotherapeutische Äquivalente sind die wichtigsten Quellen von wiederholt evaluiertem therapeutischem Wissen zu Heilpflanzen. Die klinische Fachliteratur erwies sich als zuverlässiger und verifizierbarer Korpus empirischer Evidenz, der mit aktuellen wissenschaftlichen Untersuchungen übereinstimmte. Das neu entwickelte PHA-Verfahren bietet ein Kodierungs­Instrument für das systematische Erfassen und Auswerten empirischer Daten zur Wirksamkeit und Sicherheit von traditionellen pflanzlichen Arzneimitteln. Das PHA­Verfahren wird als praktikables und effizientes Instrument zur Erweiterung der Evidenz­Typologien empfohlen, indem es therapeutische Indikationen für traditionelle pflanzliche Arzneimittel untermauern kann, so dass diese medizinisch und kulturell wichtigen Therapeutika in einen evidenz-basierten regulatorischen Rahmen integriert werden können.

First-in-Human Study with Eight Patients Using an Absorbable Vena Cava Filter for the Prevention of Pulmonary Embolism.

PURPOSE: To prospectively evaluate the initial human experience with an absorbable vena cava filter designed for transient protection from pulmonary embolism (PE). MATERIALS AND METHODS: This was a prospective, single-arm, first-in-human study of 8 patients with elevated risk of venous thromboembolism (VTE). Seven absorbable IVC filters (made of polydioxanone that breaks down into H2O and CO2 in 6 mo) were placed prophylactically before orthopedic (n = 5) and gynecologic (n = 2) surgeries, and 1 was placed in a case of deep vein thrombosis. Subjects underwent CT cavography and abdominal radiography before and 5, 11, and 36 weeks after filter placement to assess filter migration, embolization, perforation, and caval thrombosis and/or stenosis. Potential PE was assessed immediately before and 5 weeks after filter placement by pulmonary CT angiography. RESULTS: No symptomatic PE was reported throughout the study or detected at the planned 5-week follow-up. No filter migration was detected based on the fixed location of the radiopaque markers (attached to the stent section of the filter) relative to the vertebral bodies. No filter embolization or caval perforation was detected, and no caval stenosis was observed. Throughout the study, no filter-related adverse events were reported. CONCLUSIONS: Implantation of an absorbable vena cava filter in a limited number of human subjects resulted in 100% clinical success. One planned deployment was aborted as a result of stenotic pelvic veins, resulting in 89% technical success. No PE or filter-related adverse events were observed.

VOICES: South Island pilot survey of bereaved people.

AIMS: To test the feasibility of surveying bereaved next-of-kin in the South Island about their perceptions of end-of-life care for people over 18 years of age; to report results; and to identify issues for future research. METHOD: The study used the VOICES (Views of Informal Carers Evaluation of Services) questionnaire from the UK, adapted for use in Aotearoa New Zealand. Identification of next-of-kin for all South Island deaths September-November 2017 was undertaken by a commercial firm specialising in such work. Addresses of next-of-kin were sought from the Electoral Roll, with 1,813 eligible people identified and 272 (15.0%) next-of-kin unable to be traced. Surveys were posted out once only, with options to complete by mail, online, by telephone or with a face-to-face interview. RESULTS: Of the 1,541 surveys distributed, 514 (33.4%) were completed. Results confirmed the suitability of the locally modified VOICES instrument and research process. The quality of care overall was rated most highly in hospice or own home, but only a minority were able to die in these settings. Nevertheless, relatives indicated that most people died 'in the best place'. CONCLUSIONS: The VOICES questionnaire is acceptable to respondents and there are viable methods for seeking a population sample. Aspects of the questionnaire require modification before wider use. The information obtained can help district health boards, hospices other healthcare providers, and consumers in planning for end-of-life care.

Living well with chronic pain: a classical grounded theory.

Purpose: There is little theory to explain how and why some people cope well despite chronic pain. This study proposes a mid-level theoretical explanation for those that cope well, shedding light on factors relevant to acceptance.Method: Classical grounded theory methodology was closely followed to generate a theory grounded in data obtained from community-dwelling people self-identified as living well despite chronic pain.Results: The main concern of people experiencing chronic pain is resolving the problem of disrupted self-coherence. Resolution involves re-occupying self by (1) making sense of pain using an idiographic model; (2) deciding to turn from patient to person, facilitated or hindered by interactions with clinicians and occupational drive; and (3) flexibly persisting, where occupational engaging and coping allow individuals to develop future plans.Conclusions: This theory demonstrates the importance of engaging in occupation during rehabilitation by framing chronic pain adjustment within a process of renegotiating the self-concept. Occupations allow individuals to express values important to their sense of self. Coping strategies are used to enable occupation and are judged by their workability in this context. When developing goals and plans with people living with pain, rehabilitation professionals should consider an individual's position within the processes involved in learning to live well.Implication for rehabilitationLiving well with chronic pain involves a process of making sense, deciding to move on with life, and flexibly persisting.Diagnosis should be accompanied by messages about hurt and harm not being equivalent, and the need for a lifelong approach to managing a chronic problem.An idiographic depiction or formulation of a person's pain and disability provides opportunities for making sense of symptoms and collaborating on treatment goals.Remaining supportive, providing "small acts" demonstrating that the person is unique and being thought of, and encouraging engagement in valued occupations allows patients to experiment with, and start to engage in what is important in their lives.Clinicians should help people extend their coping repertoire and encourage flexibility with how these are applied in the pursuit of valued occupations.The positive motivation that comes from individuals identifying highly valued occupations is an aspect that all clinicians, but particularly occupational therapists, should recognize.

The Prevalence of Body Mass Index-Associated Chronic Diseases in Diverse Ethnic Groups in New Zealand.

The use of universal body mass index (BMI) cutoffs do not take into account variation in the association between BMI and health risk across diverse ethnic groups. We used the New Zealand Health Survey data collected between 2002/2003 and 2014/2015 to calculate the predictive marginal means of hypertension, cardiovascular diseases, and type 2 diabetes mellitus (T2DM) after adjusting for demographic variables and health-related behaviors. Compared with European group, we found that Pacific had a lower prevalence of hypertension at a BMI of ≥35 kg/m2, and Maori had a higher prevalence of hypertension, T2DM, and cardiovascular diseases at higher BMI intervals. Whereas Asian had a higher T2DM prevalence compared with Maori, Pacific, and European at some BMI intervals. Using universal BMI cutoffs on the ethnically diverse population to compare obesity rates does not address the risk of chronic diseases associated with high BMI and may stigmatize certain ethnic groups.

"I Want to Walk with My Moko." The Application of Social Cognitive Theory in the Creation of a Diabetes Prevention Documentary with New Zealand Maori.

Type 2 diabetes is almost three times more prevalent in the indigenous people of New Zealand (Maori) than non-Maori. Despite the high rate of diabetes there is a low level of diabetes knowledge and awareness in the Maori community. Several studies of Maori health identify a need for new health communication approaches to diabetes prevention in order to reduce the gap between Maori and non-Maori disease rates. We applied a Community-Based Participatory Research (CBPR) framework and behavioral theory to create a culturally appropriate documentary for Maori at risk for type 2 diabetes. We discuss how we utilized Bandura's social cognitive theory to provide a culturally sensitive theoretical basis for behavior change messaging. We outline why social cognitive theory was a culturally appropriate foundation and describe the role of the community in shaping the documentary messaging. A culture-centered approach utilizing participatory methodologies and culturally sensitive behavioral change theory might serve as a model for creating health communication resources in collaboration with other indigenous communities.

Office design and health: a systematic review.

AIM: To carry out a systematic review of recent research into the effects of workplace design, comparing individual with shared workspaces, on the health of employees. METHODS: The research question was "Does workplace design (specifically individual offices compared with shared workspaces) affect the health of workers?" A literature search limited to articles published between 2000 and 2017 was undertaken. A systematic review was carried out, and the findings of the reviewed studies grouped into themes according to the primary outcomes measured in the studies. RESULTS: The literature search identified 15 relevant studies addressing health effects of shared or open-plan offices compared with individual offices. Our systematic review found that, compared with individual offices, shared or open-plan office space is not beneficial to employees' health, with consistent findings of deleterious effects on staff health, wellbeing and productivity. Our findings are also consistent with those of earlier reviews. CONCLUSION: These findings have public health implications for the New Zealand workforce. Decisions about workplace design should include weighing the short-term financial benefits of open-plan or shared workspaces against the significant harms, including increased sickness absence, lower job satisfaction and productivity, and possible threats to recruitment and retention of staff.

Epidemiology of dental caries among adolescents in Tamil Nadu, India.

OBJECTIVE: Economic and dietary changes in the Indian state of Tamil Nadu have led to compromised oral health status of the adolescent population. Adequate epidemiological data are not available to address the prevention or treatment needs in this region of India. The aim of this study was to measure the prevalence and severity of dental caries among adolescents of Tamil Nadu, a southern state of India. METHODS: The study sample included 974 adolescent school students (12-15 years of age) from both rural and urban areas of Tamil Nadu, India. The decayed, missing and filled teeth (DMFT) index of these students was measured using the World Health Organization oral health survey method, in a quantitative cross-sectional study. RESULTS: The oral health survey indicated that the prevalence of dental caries among adolescents in rural and urban areas of Tamil Nadu was 61.4%, with an average DMFT score of 2.03. Multiple regression analyses indicated factors such as gender, mother's education, type of school and caste as significant predictors of dental caries. CONCLUSION: Female gender, Scheduled Caste and Tribes attending public schools in rural areas were identified as the more vulnerable populations to be affected by dental caries. Oral health policies should be targeted to these adolescent populations in the Tamil Nadu region.

Applying Community-Based Participatory Research to Create a Diabetes Prevention Documentary with New Zealand Maori.

BACKGROUND: Type 2 diabetes is almost three times more prevalent in the indigenous people of New Zealand (Maori) than non-Maori. Despite the high rate of diabetes in the Maori population, little is known about their personal understanding or experience of the disease. OBJECTIVES: To engage Maori in a participatory process to develop a culturally relevant diabetes prevention documentary. METHODS: Principles of community-based participatory research (CBPR) were applied to a qualitative research design employing key informant interviews and focus groups to develop a diabetes prevention documentary. CONCLUSIONS: A CBPR approach provides an appropriate model for enacting local action-oriented approaches in the creation of a documentary that reflects Maori cultural beliefs and practices.

Prepared for what? addressing the disaster readiness gap beyond preparedness for survival.

BACKGROUND: Conventional disaster preparedness messaging focuses largely on promoting survival actions and communications planning for the immediate post-disaster period. While such preparedness is vital, we have long-observed a gap in preventive medicine and disaster planning for building personal resilience--preventatively--to persevere through prolonged recovery timeframes. There are many helpful attitudes and behaviors that people can develop to increase their readiness and capacity for drastic life changes, encompassing not only health-protective preparedness actions but health-promoting attitudes for "minding the risk" and "practicing resilience" as well. For instance, quality of life assessments and well-being interventions are widely-known for the clinically significant improvements they can produce in patient-reported outcomes. Similarly, health promotion interventions are implemented preventatively when a risk is identified yet a disease is not present, and can provide health benefits throughout people's lives, regardless of the type of adversities they eventually encounter (medical, environmental, or other). DISCUSSION: We argue there is an overlooked opportunity to leverage well-being theories and methods from clinical settings and public health practice for the purpose of preventatively boosting disaster readiness and bolstering capacity for long-term resilience. We also highlight our previously-published research indicating a role for integrating personal meaning into preparedness messages. This is an opportune time for applying well-being concepts and practices as tools for developing disaster readiness, as risk awareness grows through real-time tracking of hazardous events via social media. For example, two sudden-onset disasters occurred within ten days of each other in 2014 and caught worldwide attention for their extreme hazards, despite dramatic differences in scale. The 22 March 2014 landslide tragedy in Washington State, USA, and the 1 April 2014 Chilean earthquake and Pacific-wide tsunami alerts brought home how persistently vulnerable we all are, and how developing intrinsic personal readiness for scientifically-known risks before disaster unfolds is essential policy. Gap programming that addresses personal readiness challenges in prevention timeframes could save lives and costs. We contend that bridging this readiness gap will prevent situations where people, communities, and systems survive the initial impact, but their resilience trajectories are vulnerable to the challenges of long-haul recovery.

How and why patients use acupuncture: an interpretive phenomenological study.

INTRODUCTION: The usual drivers of health care provision, namely efficacy and cost, might be expected to drive down the use of Complementary and Alternative Medicines (CAMs), given the relative paucity of evidence of efficacy for many CAMs. Usage of CAMs remains extensive and little attention has been given to explaining this paradox. This paper explores how patients integrate acupuncture, as a CAMs exemplar, within their personal schemes of health care. METHODS: An interpretive phenomenological approach underpinned the inquiry, which gathered data from in-depth interviews with 12 participants who had recently consulted acupuncturists. Thematic analysis was conducted using a constant comparison methodology. FINDINGS: Participants mostly accessed acupuncture for musculoskeletal and pain-related conditions. Usage was often initially motivated by dissatisfaction with conventional health care, perceptions that the source of the problem had not been addressed, and sometimes was due to negative experiences with medical professionals. Previous positive outcomes with acupuncture motivated more extensive use, as did personal health ideologies. Acupuncture was viewed to be appropriate for treating chronic and quality of life health issues, while treatment-associated cost was identified as a barrier to access. CONCLUSIONS: CAMs usage has been explained variously by 'push' and 'pull' factors; however, this study has shown that reasons for patient use of acupuncture may be complex and change over time. This qualitative study suggests that acupuncture fulfils specific health needs unmet in conventional health care, but also that patients view CAMs treatment as part of a broader and more pluralistic scheme of health care.

Generation Y New Zealand Registered Nurses' views about nursing work: a survey of motivation and maintenance factors.

AIM: The aim of this article was to report on the analysis of qualitative, open text data, received from a national on-line survey of what factors Generation Y New Zealand Registered Nurses wish to change about nursing and consideration of the potential policy and practice impacts of these requests on their retention. BACKGROUND: Prior to the economic recession of 2007-2010, the growing shortage of nurses in New Zealand presented a serious concern for the healthcare workforce. Given the ageing New Zealand nursing workforce, an ageing population and the increasing demands for health care, it is imperative that issues of retention of Generation Y nurses are resolved prior to the imminent retirement of more experienced nurses. DESIGN: A descriptive exploratory approach using a national wide, on-line survey, eliciting both quantitative and qualitative data was used. METHOD: The survey, conducted from August 2009-January 2010, collected data from Generation Y New Zealand Registered Nurses (n = 358) about their views about nursing, work and career. Herzberg's Motivation-Hygiene theory was used as the framework for the analysis of the open text data. RESULTS: The factors that nurses wanted changed were skewed towards Herzberg's hygiene-maintenance factors rather than motivating factors. This is of concern because hygiene-maintenance factors are considered to be dissatisfiers that are likely to push workers to another employment option.

A qualitative systematic review of patients' experiences of acupuncture.

OBJECTIVES: To present the results of a systematic review of studies on acupuncture patients' health beliefs and treatment experiences. SEARCH STRATEGY: The search was conducted using CINAHL, PubMed, Ovid MEDLINE, ISI Web of Science, and PsychINFO for qualitative and mixed-methods studies expressing the voice of acupuncture patients. Reference lists of relevant articles were also searched. The review was restricted to studies published in English. DATA COLLECTION AND ANALYSIS: Study selection, quality appraisal, and data extraction were performed sequentially. Quality was appraised using the Joanna Briggs Institute Qualitative Assessment and Review Instrument, and the Dedoose mixed methods tool was used in data management and analysis. RESULTS: Four overarching themes were identified: reasons for using acupuncture, treatment experiences, treatment outcomes, and therapeutic model. CONCLUSIONS: Patients' reasons for using acupuncture are diverse and include dissatisfaction with conventional medicine and attraction to holistic and empowering models of healthcare. Treatment is thought to relieve symptoms of the presenting concern and a range of other effects that improve well-being. This review highlights the need to improve understanding of patients' health-seeking behaviors and how individually meaningful treatment outcomes may be understood and assessed, particularly within complementary and alternative medicine.

Building resiliency: a cross-sectional study examining relationships among health-related quality of life, well-being, and disaster preparedness.

BACKGROUND: Worldwide, disaster exposure and consequences are rising. Disaster risk in New Zealand is amplified by island geography, isolation, and ubiquitous natural hazards. Wellington, the capital city, has vital needs for evacuation preparedness and resilience to the devastating impacts and increasing uncertainties of earthquake and tsunami disasters. While poor quality of life (QoL) is widely-associated with low levels of engagement in many health-protective behaviors, the relationships among health-related quality of life (HrQoL), well-being, and preparedness are virtually unknown. METHODS: We hypothesized that QoL and well-being affect household evacuation preparedness. We performed a quantitative epidemiologic survey (cross-sectional design) of Wellington adults. Our investigation assessed health-promoting attributes that build resiliency, conceptualized as health-protective attitudes and behaviors. Multidimensional QoL variables were measured using validated psychometric scales and analyzed for associations with evacuation preparedness, and we determined whether age and gender affected these relationships. RESULTS: We received 695 survey responses (28.5% response rate; margin of error ±3.8%; 80% statistical power to detect true correlations of 0.11 or greater). Correlational analyses showed statistically significant positive associations with evacuation preparedness for spiritual well-being, emotional well-being, and life satisfaction. No associations were found for mental health, social well-being, or gender; physical health was weakly negatively associated. Evacuation preparedness increased with age. Regression analyses showed that overall health and well-being explained 4.6-6.8% of the variance in evacuation preparedness. Spiritual well-being was the only QoL variable that significantly and uniquely explained variance in preparedness. CONCLUSIONS: How well-being influences preparedness is complex and deeply personal. The data indicate that multidimensional readiness is essential, and meaningfulness is an important factor. Inadequate levels of tangible preparedness actions are accompanied by gaps in intangible readiness aspects, such as: 1) errors in perceived exposure to and salience of natural hazards, yielding circumscribed risk assessments; 2) unfamiliarity with the scope and span of preparedness; 3) underestimating disaster consequences; and 4) misinterpreting the personal resources required for self-managing disaster and uncertainty. Our results highlight that conceptualizing preparedness to include attitudes and behaviors of readiness, integrating well-being and meaningfulness into preparedness strategies, and prioritizing evacuation planning are critical for resiliency as a dynamic process and outcome.

Health informatics community priming in a small nation: the New Zealand experience.

New Zealand (NZ) has a rapidly expanding health information technology (IT) development industry and wide-ranging use of informatics, especially in the primary health sector. The New Zealand government through the National Health IT Board (NHITB) has promised to provide shared care health records of core information for all New Zealanders by 2014. One of the major barriers to improvement in IT use in healthcare is the dearth of trained and interested clinicians, management and technical workforce. Health Informatics New Zealand (HINZ) and the academic community in New Zealand are attempting to remedy this by raising awareness of health informatics at the grass roots level via free "primer" workshops and by developing a sustainable cross-institutional model of educational opportunities. Support from the NHITB has been forthcoming, and the workshops start in early 2013. This poster presents the process, development and preliminary findings of this work.

Building an educated health informatics workforce--the New Zealand experience.

New Zealand has a rapidly expanding health information technology (IT) development industry and wide-ranging use of informatics, especially in the primary health sector. The New Zealand government through the National Health IT Board (NHITB) has promised to provide shared care health records of core information for all New Zealanders by 2014. One of the major barriers to improvement in IT use in healthcare is the dearth of trained and interested clinicians, management and technical workforce. Health Informatics New Zealand (HINZ) and the academic community in New Zealand are attempting to remedy this by raising awareness of health informatics at the "grass roots" level of the existing workforce via free "primer" workshops and by developing a sustainable cross-institutional model of educational opportunities. Support from the NHITB has been forthcoming, and the workshops started in early 2013, reaching out to clinical and other staff in post around New Zealand.

Parental support in neonatal intensive care units: a cross-cultural comparison between New Zealand and Japan.

This is a cross-cultural comparative study involving both quantitative and qualitative data analyses. This study examines sources of parental stress in the two neonatal intensive care units (NICUs) located in New Zealand and Japan and explores how cultural norms of NICU care environments influence parental stress-related experiences and nursing support. The three main sources of data collection were the following: a NICU staff interview, parental interview, and parental questionnaire survey, the PSS: NICU. Thirty-one pairs of parents in each NICU (N = 121) participated in this study. The differences between the two NICUs in terms of the NICU care environment and sources of parental stress within the NICU contexts were identified, highlighting NICU characteristics associated with the sources of stress in the two NICUs. Recognition of the norms of NICU care environments that may hinder parent-staff communication is an important element of NICU nursing practice.

Centralized drug review processes in Australia, Canada, New Zealand, and the United kingdom.

Many countries have centralized the clinical and economic assessments necessary for evidence-based drug coverage policy. We analyze such processes in Australia, Canada, New Zealand, and the United Kingdom. These countries apply comparable approaches to the assessment and appraisal of evidence but apply the processes to different types of drugs and use the reviews within different decision-making contexts. Review processes applied to all medicines and clearly tied to coverage decisions appear to influence national drug use. Rigor of process and transparency of data and rationale are believed to be important for maximizing the impact and political acceptability of the processes.

Prioritisation of elective surgery in New Zealand: The Reliability Study.

AIMS: This paper describes the rationale and methodology of a study assessing the reliability of tools for clinical prioritisation (Clinical Priority Assessment Criteria [CPAC]) of patients for elective surgery in New Zealand. METHODS: Surgeons from three specialties (general, vascular, and orthopaedic surgery) completed a computerised evaluation rating clinical vignettes across a range of diagnoses using several priority tools. The study design is described and an outline of the individual tool development and definitions is given. RESULTS: Of the 124 surgeons that participated in this study, 48% (60) were general surgeons, 21% (26) were vascular surgeons and 31% (38) were orthopaedic surgeons. The response rates in the first phase of data collection were 67%, 79%, and 63% for general, vascular, and orthopaedic surgery respectively. Completion rates were high with 100%, 93%, and 98% of the same groupings of surgeons completing the first round evaluations. A further 77% to 89% of the participants from the first round also completed the re-test evaluation. CONCLUSION: This study indicates that assessment of the reliability of CPAC tools currently in use in New Zealand is feasible using a vignette-based approach. In the future, study designs that allow for some face-to-face contact may be preferable for achieving optimal response and completion rates among surgeons. Further work from this study will focus on the individual results for each specialty and examining whether altering ethnicity status in vignettes had any effect on scoring behaviour.