11 results for Arroll, B

  • General practitioner diagnosis and management of acute knee injuries: summary of an evidence-based guideline

    Robb, G; Reid, D; Arroll, B; Jackson, R; Goodyear Smith, F (2013-12-02)

    Journal article
    Auckland University of Technology

    Aims To summarise evidence and key recommendations for general practitioner diagnosis and management of acute soft-tissue knee injuries, based on the New Zealand guideline. Methods A multidisciplinary team developed the guideline by critically appraising and grading retrieved literature using the Graphic Appraisal Tools for Epidemiology, Clinical decision rules and the Scottish Intercollegiate Guideline Network. Recommendations were derived from resulting evidence tables. Results For both diagnosis and management there is a paucity of good evidence to support diagnosis and treatment of internal derangements of the knee, hence some aspects of the guideline are guideline team consensus. Good evidence supports the use of the Ottawa Knee rules to guide decisions about the use of X-ray, and the Lachman test in diagnosing anterior cruciate ligament (ACL) tears. Evidence supports inclusion of proprioceptive training in rehabilitation programmes following ACL reconstruction and in people with ACL-deficient knees. There is good evidence that ultrasound is of little benefit, and there is no evidence that physiotherapy be routinely advocated following meniscectomy. Conclusion This guideline provides an evidence-based framework for diagnosis and management of internal derangements of the knee following acute injury. Moreover, its development highlights significant gaps in the evidence base and identifies priorities for new research.

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  • 30-year trends in stroke rates and outcome in Auckland, New Zealand (1981-2012): a multi-ethnic population-based series of studies

    Feigin, VL; Krishnamurthi, RV; Barker-Collo, S; McPherson, KM; Barber, PA; Parag, V; Arroll, B; Bennett, DA; Tobias, M; Jones, A; Witt, E; Brown, P; Abbott, M; Bhattacharjee, R; Rush, E; Suh, FM; Theadom, A; Rathnasabapathy, Y; Te Ao, B; Parmar, PG; Anderson, C; Bonita, R; ARCOS IV Group

    Journal article
    Auckland University of Technology

    Insufficient data exist on population-based trends in morbidity and mortality to determine the success of prevention strategies and improvements in health care delivery in stroke. The aim of this study was to determine trends in incidence and outcome (1-year mortality, 28-day case-fatality) in relation to management and risk factors for stroke in the multi-ethnic population of Auckland, New Zealand (NZ) over 30-years.

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  • Diabetes Management by Primary Health Care Nurses in Auckland, New Zealand

    Daly, BM; Arroll, B; Sheridan, N; Kenealy, T; Scragg, R (2011)

    Conference item
    The University of Auckland Library

    Methods PHC nurses in Auckland (a 26% random sample) were asked to complete postal and telephone questionnaires (86% response rate), on education, experience, knowledge and diabetes management practice, and to log their care given to diabetes patients on a randomly selected day (n=265). Results Responses were received from 287 PHC nurses (86% response rate) comprising 210 practice nurses (PN), 49 district nurses (DN) and 28 specialist nurses (SNs). Most nurses (96%) were able to identify excess body weight as a major risk factor for type 2 diabetes and elevated blood glucose levels (BGLs) or glycosylated haemoglobin (HbA1c) (86%) for diabetes-related complications. In contrast, CV risk factors were less well identified, particularly smoking, although more by SNs (43%) than PNs (14%) and DNs (12%, p=0.0005). CV complications, especially stroke, were less well known than microvascular complications, and by significantly fewer PNs (13%) and DNs (8%) than SNs (36%, p=0.002). Stronger associations were found between nurse’s knowledge of elevated HbA1c as a risk factor for diabetes-related complications and management activities related to BGLs and medication, compared with knowledge of CV risk factors, which was not associated with assessment of blood pressure or knowledge of patient’s total cholesterol or smoking status. The median number of patients consulted on the randomly selected day was one by 38% of PNs, two by 47% of DNs and 4-5 by 57% of SNs. Overall, PNs consulted almost 60% of the patients sampled, while patients consulted by DNs were older and more likely to be European New Zealanders, tobacco uses and have diabetes-related complications and co-morbidities, while SNs consulted by Maori and Pacific patients. Conclusion: There is a need for PHC nurses to increase their knowledge of CV risk factors with more effective management required and particularly of smoking.

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  • Diabetes Management by Primary Health Care Nurses in Auckland, New Zealand

    Daly, Barbara; Arroll, B; Sheridan, N; Kenealy, T; Scragg, R (2011-11-04)

    Conference poster
    The University of Auckland Library

    Methods PHC nurses in Auckland (a 26% random sample) were asked to complete postal and telephone questionnaires (86% response rate), on education, experience, knowledge and diabetes management practice, and to log their care given to diabetes patients on a randomly selected day (n=265). Results Responses were received from 287 PHC nurses (86% response rate) comprising 210 practice nurses (PN), 49 district nurses (DN) and 28 specialist nurses (SNs). Most nurses (96%) were able to identify excess body weight as a major risk factor for type 2 diabetes and elevated blood glucose levels (BGLs) or glycosylated haemoglobin (HbA1c) (86%) for diabetes-related complications. In contrast, CV risk factors were less well identified, particularly smoking, although more by SNs (43%) than PNs (14%) and DNs (12%, p=0.0005). CV complications, especially stroke, were less well known than microvascular complications, and by significantly fewer PNs (13%) and DNs (8%) than SNs (36%, p=0.002). Stronger associations were found between nurse’s knowledge of elevated HbA1c as a risk factor for diabetes-related complications and management activities related to BGLs and medication, compared with knowledge of CV risk factors, which was not associated with assessment of blood pressure or knowledge of patient’s total cholesterol or smoking status. The median number of patients consulted on the randomly selected day was one by 38% of PNs, two by 47% of DNs and 4-5 by 57% of SNs. Overall, PNs consulted almost 60% of the patients sampled, while patients consulted by DNs were older and more likely to be European New Zealanders, tobacco uses and have diabetes-related complications and co-morbidities, while SNs consulted by Maori and Pacific patients. Conclusion: There is a need for PHC nurses to increase their knowledge of CV risk factors with more effective management required and particularly of smoking.

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  • Growing pains: Parents and children need reassuring about this self limiting condition of unknown cause

    Goodyear-Smith, Felicity; Arroll, B (2006)

    Journal article
    The University of Auckland Library

    Growing pains are typically non-articular, inter-mittent bilateral aches or pains in the legs that occur in the evening or at night in children aged 3-12 years. They are not associated with limping or limited mobility and do not involve the joints (all of which are recognised signs of pathology); no signs of local trauma or infection are seen.

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  • Prescribing information resources: use and preference by New Zealand general practitioners

    Goodyear-Smith, F; Arroll, B; Patrick, D; Kerse, N; Harrison, J; Halliwell, J; Pearson, J; Lay-Yee, R (2006)

    Journal article
    The University of Auckland Library

    Aims To identify sources New Zealand (NZ) general practitioners (GPs) use to inform themselves about prescribing issues; how they keep their informa-tion up-to-date, and factors influencing prescribing decisions. Methods Computer-assisted telephone interviews of 99 randomly-selected NZ GPs in 2004. Results Seventy-two per cent response rate. MIMS/New Ethicals was the most com-monly used resource but is reported to be limited in the information it pro-vides. There was no single source of prescribing information identified by this group of NZ GPs. Despite frequent use of computers in general practice, use of prescribing websites was low. Barriers to Internet use for prescribing were lack of: time; awareness; fast access; and computer literacy. Rapidly-accessed resources are reported to be more likely to be used in clinical decision-mak-ing than higher quality but slower access ones. Costs to patients and direct-to- consumer advertising were identified as influences on prescribing. Implications Useful Internet sites allow for easy electronic searching and easily digestible summarised information in a user-friendly format. A one-stop Internet re-source with fast access which is up-to-date, comprehensive and NZ-orien-tated with respect to drug availability and funding would maintain quality reliable information. NZ GPs are not currently maximising the potential of Internet-based medication prescribing decision support.

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  • An association between ethnicity and cardiovascular outcomes for people with Type 2 diabetes in New Zealand

    Kenealy, T; Elley, CR; Robinson, E; Bramley, D; Drury, PL; Kerse, NM; Moyes, SA; Arroll, B (2008)

    Journal article
    The University of Auckland Library

    Aims To investigate the association between ethnicity and risk of first cardiovascular (CV) event for people with Type 2 diabetes in New Zealand. Methods A prospective cohort study using routinely collected data from a national primary health care diabetes annual review programme linked to national hospital admission and mortality data. Ethnicity was recorded as European, Maori, Pacific, Indo-Asian, East-Asian or Other. A Cox proportional hazards model was used to investigate factors associated with first CV event. Data was collected from 48 444 patients with Type 2 diabetes, with first data collected between 1 January 2000 and 20 December 2005, no previous cardiovascular event at entry and with complete measurements. Risk factors included ethnicity, gender, socio-economic status, body mass index, smoking, age at diagnosis, duration of diabetes, systolic blood pressure, serum lipids, glycated haemoglobin and urine albumin : creatinine ratio. The main outcome measures were time to first fatal or non-fatal CV event. Results Median follow-up was 2.4 years. Using combined European and Other ethnicities as a reference, hazard ratios for first CV event were 1.30 for Maori (95% confidence interval 1.19–1.41), 1.04 for Pacific (0.95–1.13), 1.06 for Indo-Asian (0.91–1.24) and 0.73 for East-Asian (0.62–0.85) after controlling for all other risk factors. Conclusions Ethnicity was independently associated with time to first CV event in people with Type 2 diabetes. Maori were at 30% higher risk of first CV event and East-Asian 27% lower risk compared with European/Other, with no significant difference in risk for Pacific and Indo-Asian peoples.

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  • Patients’ Preferences for Ways to Communicate Benefits of Cardiovascular Medication

    Goodyear-Smith, Felicity; Kenealy, T; Wells, S; Arroll, B; Horsburgh, M (2011)

    Journal article
    The University of Auckland Library

    PURPOSE We wanted to determine patients’ willingness to take preventive cardiovascular disease (CVD) medication in relation to their 5-year CVD risk score and modes of communicating benefits of therapy. METHODS Study participants were 934 consecutive patients drawn from family practitioners’ waiting rooms in Auckland, New Zealand, who knew their 5-year CVD risk (ranging from 5% to 30%) and who completed a questionnaire asking them to rate how much various modes of communicating the benefits of therapy would encourage them to take medication daily, where the benefits from medication were proportional to their estimated CVD risk score. RESULTS Patients’ rankings for modes of communicating the benefits of therapy were little influenced by sex, age, ethnicity, numeracy score, 5-year CVD risk, or concern about a heart attack. Patients clearly found relative risk reduction most encouraging, with absolute risk reduction rated second overall and numbers needed to treat the least likely to be persuasive, although preferences covered the full range and were not predictable from demographic or 5-year CVD risk data. Pictures were preferred to numbers by 55.1%, with a people-chart or a bar chart being equally favored. Even so, 61.8% preferred a doctor’s opinion to any presentation by numbers or pictures. CONCLUSIONS Patients’ willingness to take preventive cardiovascular medication depends more on mode of communicating treatment benefit than on their short-term CVD risk score or their level of concern about a future cardiovascular event. Because individual preferences were not predictable, more than 1 modality is likely to be clinically useful for each patient.

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  • Investigation and management of congestive heart failure.

    Arroll, B; Doughty, Robert; Andersen, V (2010)

    Journal article
    The University of Auckland Library

    Congestive heart failure is a common condition that increases in prevalence with increasing age. In 2003, guidance from the National Institute for Health and Clinical Excellence acknowledged that the “rising epidemic of heart failure” is partly the result of people living longer and the more effective treatments for coronary heart disease now available. It also acknowledged, however, that average life expectancy is only about three years after diagnosis, which is much worse than for many other serious illnesses such as cancer of the breast or colon....

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  • Foot examinations of diabetes patients by primary health care nurses in Auckland, New Zealand

    Daly, B; Arroll, B; Sheridan, N; Kenealy, TW; Scragg, R (2014-07)

    Journal article
    The University of Auckland Library

    AIMS: To identify factors associated with patients receiving foot examinations by primary health care nurses. METHODS: A cross-sectional survey of 287 randomly sampled primary health care nurses, from a total of 1091 in Auckland, completed a postal self-administered questionnaire and telephone interview. Biographical and diabetes management details were collected for 265 diabetes patients consulted by the nurses on a randomly selected day. RESULTS: A response rate of 86% was achieved. Nurses examined patient's feet in 46% of consultations. Controlling for demographic variables, foot examinations were associated with age, odds ratio (1.25, 95% CI 0.57-2.74) for patients aged 51-65 years and >66 years (2.50, 1.08-5.75) compared with those ≤50 years, consultations by district compared with practice nurses (14.23, 95% CI 3.82-53.05), special programme consultations compared with usual follow-up consults (8.81, 95% CI 2.99-25.93) and length of consultation (1.89, 0.72-4.97) for 15-30 min and (4.45, 95% CI 1.48-13.41) >30 min compared with consultations ≤15 min, or for wound care (2.58, 1.01-6.61). CONCLUSIONS: Diabetes foot examinations by primary health care nurses varies greatly, and are associated with characteristics of the patient (age, need for wound care) and the consultation (district nurses, diabetes programme and duration).

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  • Characteristics of nurses providing diabetes community and outpatient care in Auckland

    Daly, B; Arroll, B; Sheridan, N; Kenealy, Timothy; Scragg, R (2013-03)

    Journal article
    The University of Auckland Library

    INTRODUCTION: There is a worldwide trend for diabetes care to be undertaken in primary care. Nurses are expected to take a leading role in diabetes management, but their roles in primary care are unclear in New Zealand, as are the systems of care they work in as well as their training. AIM: To describe and compare demographic details, education and diabetes experience, practice setting and facilities available for the three main groups of primary health care nurses working in the largest urban area in New Zealand. METHOD: Of the total number of practice nurses, district nurses and specialist nurses working in Auckland (n=1091), 31% were randomly selected to undertake a self-administered questionnaire and telephone interview in 2006-2008. RESULTS: Overall response was 86% (n=284 self-administered questionnaires, n=287 telephone interviews). Almost half (43%) of primary care nurses were aged over 50 years. A greater proportion of specialist nurses (89%) and practice nurses (84%) had post-registration diabetes education compared with district nurses (65%, p=0.005), from a range of educational settings including workshops, workplaces, conferences and tertiary institutions. More district nurses (35%) and practice nurses (32%) had worked in their current workplace for >10 years compared with specialist nurses (14%, p=0.004). Over 20% of practice nurses and district nurses lacked access to the internet, and the latter group had the least administrative facilities and felt least valued. DISCUSSION: These findings highlight an ageing primary health care nursing workforce, lack of a national primary health care post-registration qualification and a lack of internet access.

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