87 results for Arroll, Bruce

  • Are antibiotics effective for acute purulent rhinitis? Systematic review and meta-analysis of placebo controlled randomised trials.

    Arroll, Bruce; Kenealy, Timothy (2006-08-05)

    Journal article
    The University of Auckland Library

    To systematically review the evidence for the effectiveness of antibiotics in acute purulent rhinitis (many guidelines advise against their use on the basis of one study that showed no effect).

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  • Investigation and management of congestive heart failure.

    Arroll, Bruce; 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.1 The condition is associated with poor quality of life, frequent hospital admissions, and poor survival,2 although this may have changed with the advent of better treatments. Community estimates of prevalence vary from 1.6 to 4.6 cases per 1000 in men aged 45-74 years and from 0.9 to 2.2 cases per 1000 in women. About 1% of men develop heart failure after age 75 and almost 2% after 80 years.3 This review discusses the immediate management of patients who present with the clinical syndrome of heart failure (usually a combination of dyspnoea, fatigue, exercise intolerance, and fluid retention) and the management of chronic congestive heart failure. It is based on evidence from guidelines, randomised controlled trials, and population cohorts followed for many years. We also emphasise the distinction between heart failure with low ejection fraction and heart failure with preserved ejection fraction because although plenty of evidence exists on how to treat the first entity very little exists on how to treat the second.

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  • Prescribing Information Resources: Use and preference by general practitioners: An exploratory survey of general practitioners: The overview.

    Arroll, Bruce; Goodyear-Smith, Felicity; Patrick, Daniel; Kerse, NM; Harrison, Jeffrey; Halliwell, Joan; Pearson, Janet; Lay Yee, Roy; Von Randow, M (2005)

    Report
    The University of Auckland Library

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  • New Zealand Guidelines for Rheumatic Fever. 3: Proposed Rheumatic Fever Primary Prevention Programme

    Lennon, Diana; Peat, Elizabeth; Wilson, Nigel; Atatoa-Carr, P; Kerdemelidis, Melissa; Arroll, Bruce (2009-05)

    Report
    The University of Auckland Library

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  • Should we prescribe diuretics for patients with prediabetes and hypertension

    Arroll, Bruce; Kenealy, Timothy; Elley, Carolyn (2008-12-13)

    Journal article
    The University of Auckland Library

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  • Prescribing Information Resources: Use and preference by general practitioners An exploratory survey of general practitioners

    Arroll, Bruce; Goodyear-Smith, Felicity; Patrick, Daniel; Kerse, NM; Harrison, Jeffrey; Halliwell, J; Pearson, Janet; Lay-Yee, R; von Randow, M (2005)

    Report
    The University of Auckland Library

    The Ministry of Health funded the Centre for Health Services Research and Policy (The University of Auckland) to produce a research report on general practitioners’ (GP) preferred sources for information when making prescribing decisions, and the value that GPs place in these resources. Prescribing Information Resources: Use and preference by general practitioners: An exploratory survey of general practitioners provides information on the sources of information GPs use to inform their prescribing decisions. During June and July 2004, 116 GPs were interviewed by phone, and were asked a number of questions regarding prescribing: the sources of information GPs use the factors that impact on GPs’ prescribing decision the importance attributed by GPs to each sources the sources that GPs value the most further information that GPs might like to assist them in prescribing decisions. This report is also accompanied by an overview that presents the key findings. The views expressed in this report are the personal views of the authors and should not be taken to represent the views or policy of the Ministry of Health or the Government.

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  • Thiazide diuretics 'justifiable' for hypertension in patients with pre-diabetes

    Arroll, Bruce; Kenealy, Timothy; Elley, CR (2009)

    Journal article
    The University of Auckland Library

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  • Population Health: Meaning in Aotearoa New Zealand? A discussion paper to support implementation of the Primary Health Care Strategy

    Winnard, D; Crampton, P; Cumming, J; Sheridan, Nicolette; Neuwelt, Patricia; Arroll, Bruce; Dowell, A; Matheson, D; Head, V (2008)

    Report
    The University of Auckland Library

    There is a need for shared understanding of the terms ‘population health’ and a ‘population health approach’ to support ongoing implementation of the New Zealand Primary Health Care Strategy. This paper outlines why such definitions are needed, and the rationale for the proposed definitions, in the hope of generating robust discussion to improve the collective understanding and commitment to population health gain through the implementation of the Strategy.

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  • Contribution by primary health nurses and general practitioners to the Diabetes Annual Review (Get Checked) programme in Auckland, New Zealand

    Daly, B; Kenealy, Timothy; Arroll, Bruce; Sheridan, Nicolette; Scragg, Robert (2013-08-16)

    Journal article
    The University of Auckland Library

    The 'Get Checked' annual diabetes review programme was successful in engaging practice and community-based specialist nurses in the community management of diabetes and has revealed positive relationships between nurses and doctors, extended roles for nurses and the importance of engaging nurses in the design of health care programmes. Nurses involved in the programme undertake a large proportion of all patient annual reviews at their practice and major nursing roles include measuring blood pressure, weighing patients, undertaking foot examinations and giving health promotional advice. DHBs need to continue to acknowledge the valuable contribution made by the largest health professional workforce and ensure primary health care nurses are involved in developing an effective replacement ‘Get Checked’ programme.

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  • The Auckland blood pressure control study: a randomised controlled trial of physical activity and salt restriction in persons being treated with medication for hypertension

    Arroll, Bruce (1992)

    Doctoral thesis
    The University of Auckland Library

    Introduction This thesis describes two studies: The Auckland Heart Study Validation Project which validated the physical activity questionnaire from an earlier case-control study (known as the Auckland Heart Study); The Auckland Blood Pressure Control Study which was a factorial design randomised controlled trial of physical activity and salt restriction as a means of further lowering blood pressure in a community sample of patients treated with anti-hypertensive medication. This study used the physical activity questionnaire validated in the Auckland Heart Study Validation Project. Coronary heart disease is the leading cause of death and a major cause of morbidity in New Zealand. The Auckland Heart Study was a case-control study examining coronary heart disease and its risk factors and was conducted in Auckland from 1986 to 1988 (Jackson, 1989). This study incorporated a three month recall questionnaire on physical activity. The results showed that a high level of physical activity was associated with a low rate of coronary heart disease. For example the odds ratio for those with high levels of moderate leisure time physical activity was 0.78 for men and 0.39 for women. To assess the validity of the physical activity questionnaire, the Auckland Heart Study Validation Project was conducted in 1988. Both physical inactivity and hypertension are risk factors for coronary heart disease and physical activity is known to lower blood pressure. The Auckland Blood Pressure Control study was conducted during 1989-90 in order to assess the effectiveness of physical activity as a means of lowering blood pressure in a community setting. The physical activity questionnaire used in the Auckland Blood Pressure Control study was the same one validated in the Auckland Heart Study Validation Project. This thesis describes both the Auckland Heart Study Validation Project and the Auckland Blood Pressure Control study. The Auckland Heart Study Validation Project The 186 Participants for the Auckland Heart Study Validation Project were randomly selected from the control group of the Auckland Heart Study. Of those who could be contacted, 152 completed a seven day physical activity and food intake diary. The seven day diary was the gold standard for the three month physical activity recall questionnaire used in the Auckland Heart Study. The response rate for completing the seven day diary was 82%. The original control group had been randomly chosen from the community and hence the sub-sample of 152 participants represented a reasonable cross-section of the community. The correlations for the three month recall questionnaire compared with the seven day dairy, were 0.61, 0.49 and 0.86 for moderate, vigorous and total activity respectively. These findings were consistent with other validation studies in the literature. One of the strengths of the Auckland Heart Study Validation project was that it was undertaken in the community population for which it was intended. It was concluded that the three month physical activity recall measured physical activity in general and over the three recall period. Auckland Blood Pressure Control study Low levels of physical activity have been shown in observational studies to be associated with a high incidence of both coronary heart disease and hypertension. A concern with observational studies is that the findings may be due to confounding factors which are not able to be controlled, either in the design or the analysis. The best method of controlling for confounding is through the use of randomised controlled trials. The literature on physical activity as a means of lowering blood pressure contains many randomised trials and almost all have methodological weaknesses. Moreover, most of those studies have been conducted in laboratory settings; very few trials of physical activity and blood pressure have been conducted in community settings. The literature on salt restriction as a means of lowering blood pressure contains numerous well designed randomized controlled trials showing that salt restriction can lower blood pressure. While significant results have been achieved from salt restriction most of these studies have been involved intensive input from dietitians. None of the community based studies have demonstrated significant blood pressure reductions. The aim of the Auckland Blood Pressure Control study was to assess the effectiveness of physical activity and/or salt restriction as therapies to lower blood pressure in treated hypertensive patients in a community setting. The research design was a factorial design randomised controlled trial of physical activity and salt restriction as therapies for lowering blood pressure. Participants were recruited for the study from general practitioners and a variety of public advertisements. The study was conducted over six months and 181 of the baseline 208 participants completed the study. The two interventions were brisk walking for 40 minutes, three times a week and salt restriction advice. The main outcome measures were blinded blood pressures measured at three and six months. The average age of the participants was 55 years and there were approximately equal numbers of men and women. At the three month interview there was a statistically reduction in systolic blood pressure for salt restriction and physical activity as separate therapies, but not for the combination. There was no significant reduction in diastolic blood pressure at the three or six month assessment. Although the Auckland Heart Study three month recall questionnaire was valid for the case-control study there was concern that it was not sensitive enough for the randomised controlled trial. It was concluded that both physical activity and salt restriction lowered systolic blood pressure, at least in the short term, in persons with hypertension treated with medication in a community setting.

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  • New Zealand Guidelines for Rheumatic Fever. 2: Group A Streptococcal Sore Throat Management

    Lennon, Diana; Peat, Elizabeth; Arroll, Bruce; Kerdemelidis, Melissa (2008-05)

    Report
    The University of Auckland Library

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  • The assessment and management of insomnia in primary care.

    Falloon, K; Arroll, Bruce; Elley, Carolyn; Fernando, Antonio (2011)

    Journal article
    The University of Auckland Library

    Insomnia affects a third of people and is a common cause of consultation in primary care History is the main diagnostic tool There are many causes of secondary insomnia, which should be ruled out and treated first Excessive daytime sleepiness should raise questions about obstructive sleep apnoea Primary insomnia is diagnosed after excluding other causes of insomnia. It can be treated effectively by sleep hygiene techniques, by restricting time in bed, or with behavioural interventions Sedatives should be used as a last resort when other approaches have failed because of risks of tolerance and adverse effects

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  • Putting Population Health into Practice Through Primary Health Care

    Neuwelt, Patricia; Matheson, D; Arroll, Bruce; Dowell, A; Winnard, D; Crampton, P; Sheridan, Nicolette; Cumming, J (2009)

    Journal article
    The University of Auckland Library

    The introduction of the Primary Health Care Strategy has offered opportunities to take a population health approach to the planning and delivery of primary health care. The lack of a common understanding of population health between primary care and public health has been the prompt for a group of academics and practitioners to join forces and produce this statement on a population health approach to primary care, through primary health care. This paper takes the position that the features of a population health approach (such as a concern for equity, community participation, teamwork and attention to the determinants of health) enhance general practice care rather than undermine it. We conclude that the contribution of the health sector towards population health goals can be achieved through collaboration between GPs, nurses, other primary health care workers, and communities, together with health promotion and public health practitioners. Finding common language and understanding is an important step towards improving that collaboration.

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  • Antibiotic use for common cold

    Kenealy, Timothy; Arroll, Bruce (2009)

    Book item
    The University of Auckland Library

    Antibiotics do not help patients with an uncomplicated common cold. Antibiotics can have side effects for the individual taking them that range from unpleasant to serious, even lethal. Antibiotic use also contributes to communal harm by encouraging antibiotic resistance. If there can be no benefit, but there can be harm, why is the common cold the commonest reason for doctors to prescribe antibiotics? We note that antibiotics are also overused in other conditions and other medical disciplines, as well as in agriculture and the food industry. The harm caused by antibiotics ranges from mild gastrointestinal disturbance to death. Reasons for overuse of antibiotics to treat the common cold include patient expectations, patient and doctor uncertainty around diagnosing complications of the common cold, and the pressure on the doctor to ‘do something doctor — anything’. Strategies to limit inappropriate antibiotic use are explored, particularly the use of ‘delayed prescriptions’, and evidence is presented that with education of doctors and patients the overuse can be reduced.

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  • Stroke prevention in New Zealand: Can we do better?

    Feigin, VL; Krishnamurthi, R; Barber, Peter; Arroll, Bruce (2013)

    Journal article
    The University of Auckland Library

    There are approximately 45 000 stroke survivors in New Zealand and this number is projected to increase to 50 000 survivors, with annual costs to the health system exceeding $700 million by 2015 if no effective primary stroke prevention strategies are introduced. However, development of evidence-based stroke prevention strategies requires answering several research questions. In this article, we summarize some key research questions that are particularly pertinent to stroke prevention in New Zealand.

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  • Time for a rethink of treatment for patients with depression in primary care

    Arroll, Bruce; Moir, Fiona (2010-09)

    Journal article
    The University of Auckland Library

    The publication of a paper showing that mindfulness-based cognitive therapy prevented relapse of depression in a group of primary care patients at high risk of relapsing, is another reminder of the importance about these nonpharmacological therapies and should make us rethink what we are doing with treatment of depression in primary care. ....

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  • Antibiotics for acute bronchitis - Four reviews and still no answers: our clinical definitions are at fault

    Arroll, Bruce; Kenealy, Timothy (2001)

    Journal article
    The University of Auckland Library

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  • Quantification of diabetes consultations by the main primary health care nurse groups in Auckland, New Zealand

    Daly, Barbara; Arroll, Bruce; Sheridan, Nicolette; Kenealy, Timothy; Scragg, Robert (2016-09)

    Journal article
    The University of Auckland Library

    Diabetes prevalence continues to increase, with most diabetes patients managed in primary care.This report quantifies the number of diabetes consultations undertaken by primary healthcare nurses in Auckland, New Zealand.Of 335 primary healthcare nurses randomly selected, 287 (86%) completed a telephone interview in 2006-2008.On a randomly sampled day (from the past seven) for each nurse, 42% of the nurses surveyed (n=120) consulted 308 diabetes patients. From the proportion of nurses sampled in the study, it is calculated that the number of diabetes patients consulted by primary healthcare nurses per week in Auckland between September 2006 and February 2008 was 4210, with 61% consulted by practice, 23% by specialist and 16% by district nurses. These findings show that practice nurses carry out the largest number of community diabetes consultations by nurses. Their major contribution needs to be incorporated into future planning of the community management of diabetes.

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  • Use of antidepressants for depression in primary care

    Arroll, Bruce; Elley, CR; Fishman, Tana; Goodyear-Smith, Felicity; Kenealy, Timothy; Blashki, G; Kerse, Ngaire; MacGillivray, S (2010)

    Journal article
    The University of Auckland Library

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  • Antibiotics and acute purulent rhinitis: Authors' reply

    Arroll, Bruce; Kenealy, Timothy (2006-08-17)

    Journal article
    The University of Auckland Library

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