John Pickering

Dr John Pickering is an Associate Professor in the Department of Medicine at the University of Otago, Christchurch and a Senior Research Fellow in Acute Care in the Emergency Department of Christchurch hospital. John aims to blog on science, health, and occasionally political issues. He believes publicly funded science should be made public - so publishes regular "cheesecake files" about his own research. John is on Twitter @kiwiskinz

An even quicker way to rule out heart attacks - Kidney Punch

Apr 18, 2017

The majority of New Zealand emergency departments look for heart muscle damage by taking a sample of blood and looking for a particular molecule called a high-sensitivity troponin T (hsTnT).  We have now confirmed that rather than two measurements over several hours just one measurement on arrival in the ED could be used to rule out heart attacks in about 30% of patients. What did we do? We think this is a big deal. We’ve timed this post to meet the Annas of Internal Medicine timing for when our work appears on their website – here.  What we did was to search the literature to find where research groups may have measured hsTnT in the right group of people – namely people appearing in an emergency room whom the attending physician thinks they may be having a heart attack. We also required … Read More

To march or not to march? - Kidney Punch

Apr 17, 2017

When I’ve marched in the past it has been to protest or celebrate.  The call for a March for Science, due to take place in New Zealand on the 22nd of April, has me confused as to its purpose. When I first heard the suggestion of a March for Science in New Zealand I admit I was immediately sceptical (occupational hazard).  The suggestion had come in response to the policies of the Trump administration in the USA.  I am appalled by many of them and by the apparent ignoring of the scientific consensus – but then given the flip-flop on so much that was said in the campaign, it would take a brave person to predict there won’t be a similar flip-flop with respect to climate change policies and the like. That aside, is the March in New Zealand intended to be … Read More

Aunty Cecily - Kidney Punch

Mar 09, 2017

This International Women’s Day I read a re-post of a wonderful article about Otago University women in science.  I thought I’d add another one, my Aunt Cecily, or to the rest of the world Dame Cecily Pickerill. Dame Cecily Pickerill. Aunty Cecily was clever, determined, and, yes, a tough woman.   It was those qualities that helped her to help many people. She was born, Cecily Mary Aroha Wise Clarkson in Taihape in 1903 less than 18 months after her parents had arrived from England. Taihape in those days was forests, mud, a building boom and horses.  It appears to have also been a place she could get a good education.  At a young age, just 18, she made it all the way to Dunedin to attend Otago Medical School.  By then her family was in Auckland.  I don’t … Read More

Big data + Big science = Big health - Kidney Punch

Feb 03, 2017

Big data and big science are buzz phrases in health research at the moment.  It is not at all apparent what the exact definition of these are or should be and whether they will be short lived in our lexicon, but I think it reasonable to assume that where there is buzz there is honey. Big Data I think of big data in health as information routinely collected by our interaction with health systems, both formal (eg GPs or hospitals) and informal (eg networked devices that continuously monitor our heart beat).  Through ever improving connectivity such data may become available (anonymously) for the health researcher and policy maker.  The statistical tools needed to analyse this volume of data without producing spurious correlations are still being developed and there are some genuine ethical concerns that must be addressed. Within New Zealand we … Read More

Heart attacks in NZ – are women getting a raw deal? - Kidney Punch

Aug 31, 2016

This week the NZ Herald published an article saying doctors are failing to spot heart attacks in thousands of women.  This sounds alarming, could it be happening in NZ? Are women getting a raw deal? Important questions.  This post looks at the study behind the media and then at how heart attacks are being diagnosed in New Zealand. The Herald article is evidently based on press releases related to a study published to coincide with the European Society of Cardiologist’s conference currently underway in Rome and attended by some 30,000 cardiologists, other physicians, industry types, and the Pope (yep!). The study in question comes from the University of Leeds. Here’s the Leeds Uni press release. The US red-dress logo which is their national symbol for women and heart disease The study The study is based on an … Read More

Blood biomarker for heart attacks - Kidney Punch

Jun 02, 2016

Every now and again a Journal doesn’t want us to talk publicly about our own paper until it they publish it.  This is simply so they can make more of a splash with it.  This was the case of an article I have been involved with published today in the Cardiology journal of the American Medical Association*.  What’s it about? Ruling out a heart attack in the emergency department is difficult.  Readers of this blog would have read about various other ways we’ve developed to be part of it (eg here).  They depend on many things including the type of blood measurement used and the timing of that.  These markers – called troponins – detect damage to the heart muscle. In this study led by Ed Carlton of Southmead hospital in Bristol, UK, we evaluated whether … Read More

Cheesecake files: A little something for World Kidney Day - Kidney Punch

Mar 10, 2016

Today is World Kidney Day, so I shall let you in on a little secret. There is a new tool for predicting if a transplant is going to be problematic to get working properly. Nephrologist call a transplant a “graft” and when the new kidney is not really filtering as well as hoped after a week they call it “Delayed Graft Function.”  Rather than waiting a week, the nephrologist would like to know in the first few hours after the transplant if the new kidney is going to be one of these “problematic” transplants or not.  A lot of money has been spent on developing some fancy new biomarkers (urinary) and they may well have their place.  At this stage none are terribly good at predicting delayed graft function. A while ago I helped develop a new tool – simply … Read More

Cheesecake files: A world second for heart attacks - Kidney Punch

Mar 07, 2016

Going to the Emergency Department with chest pain no longer means an almost certain night in hospital.  Friday saw the publication online of our randomised controlled trial comparing two different strategies to rapidly rule-out heart attacks in people who present with chest pain to hospitals.  Here’s a précis: What’s the problem? Chest pain is common – 10% or so of presentations to ED are for chest pain. Heart attacks are not so common – only ~10-15% in NZ (and less overseas*) actually have a heart attack. It is devilishly difficult for most chest pain to rapidly rule out the possibility of a heart attack. Consequently, most people get admitted to hospital (in 2007 93% of those presenting with chest pain). But – led by Dr Martin Than in Christchurch and an international group including Dr Louise Cullen in … Read More

The effect of cannabis legalisation on Emergency Care  - Kidney Punch

Feb 27, 2016

Medical cannabis application guidelines are to be reviewed, announced Associate Health Minister Peter Dunne this week. Co-incidently a paper was published* in the Annals of Emergency Medicine on the effect on Emergency Care of legalising medical marijuana use in Colorado. Alas, this article is behind a paywall.  It does not have a lot of detail. However, it is relevant to the New Zealand debate.  Not so much as to any possible change in guidelines on applications made to the minister, but rather to the effect a broader legalisation of marijuana for medical purposes may  have an on our emergency departments. i.e. just one of the many factors which need to be taken into account in the debate. In 2009 the prosecution of marijuana users and suppliers was halted in the state of Colarado where the use of medical marijuana had been previously legalised and licensed.  … Read More

What’s going on at the UOC? - Kidney Punch

Feb 09, 2016

Q. What has Mars, Epidemics, Heart Disease, Infection, and Pacifika got in common? A. They are all central to research project at the University of Otago Christchurch (UOC). Here are some excerpts for the UOC summer newsletter (Written by UOC communications manager, Kim Thomas). Christchurch in NASA Mars project role University of Otago, Christchurch, researchers are playing a crucial role in research that will assist in NASA’s mission to Mars. Thee Christchurch researchers are scanning the brains of explorers who have wintered in Antarctica as part of a NASA /German Aerospace Center project to understand what impact living in extreme environments has on the human brain. The research will be relevant for NASA’s plans to send humans to Mars. The shortest possible return trip to the red planet would take two years. The international research team is led by the University … Read More