SciBlogs

Archive February 2013

2 years on the Papanui campus remembers and celebrates John Pickering Feb 22

This post is published at 12:51 February 22 2013 – exactly 2 years to the day from the deadly Christchurch quake and 5.5km from where I was on that day.  This morning I met with a PhD student as she prepares the penultimate version of her thesis.  Two years ago she, I, another PhD student and several others from my research group occupied the “clip on” on the University of Otago Christchurch building above the main entrance of Christchurch Hospital. Less than 24 hours later the Papanui campus was established.  First PhD student was within one month of submission of her thesis.  The first task was to rescue as much of the thesis as we could from USB sticks etc.  Fortunately we managed to put together enough to get on with, and her thesis eventually had a successful outcome.

My OfficeWhen I reflect now, I just got on with what I knew I could do. I left my medical colleagues in the hospital to get on with what they knew best.  I stood outside the hospital main entrance and saw the first casualties being brought in. Once I was sure that my students and colleagues were OK to find their way home, like thousands of others I started walking home to check on my own family.  In the meantime, others worked.  Yesterday I heard Prof Michael Ardagh, head of the Emergency Department, talk about the response of the hospital staff and medical students.  It is a remarkable story – it worked, and lives were saved, because plans were in place.  It worked because the staff put others ahead of themselves.  This was not just the doctors and nurses.  It was the med students who ran errands, the maintenance staff her with ingenuity (story of a truck and syphoning diesel) kept generators running, of blood bank staff in the bowels of the hospital ankle deep in water with intermittent power processing requests from the ED and ICU, of the Canterbury Health Labs who picked up their equipment, recalibrated, and were back on line within 20 minutes.

The Papanui Campus at age 730 days

The Papanui Campus at age 730 days


The University of Otago Christchurch building is now open again.  The students are back, and the labs up and running.  I hope to get an office back sometime in the next month or two.  The scientific community from the universities of Lincoln and Canterbury, and private enterprises like Canterbury Scientific have been fantastic at opening their doors and hosting labs and staff.  Others, like myself, established themselves where they could and got on with what they could.  While there are casualties of the disruption – staff moved on (I no longer have a lab group to work with), studies interrupted (I had a study going in the ED and ICU at the time which was inevitably suspended), and grants not able to be written for lack of staff, pilot data etc, there has also been much success to celebrate.  Not least are two years of teaching which happened at various odd venues around the city including several sporting club rooms.  Prof Christine Winterbourne was awarded the highest scientific award in New Zealand in 2011 – the Rutherford Medal, and there were other awards for Uni Otago Christchurch staff too.  Just this past month some colleagues have received promotions to Professorships – deserved.  Some new research areas have begun, particularly over the health effects of a major disaster. Students have graduated, and many papers have been published (12 & a book chapter for me in the last 2 years :) ).  Plenty to celebrate.

Across the front of the University of Otago Christchurch building are the words “Research Saves Lives.”  Decades of research saved lives on 22 February 2011.  The research in the years since will save lives in the years to come.  Well done colleagues.  Thank you Canterbury for the support.

Tagged: christchurch, Earthquake, Research, university of otago

Live from UOC 40th anniversary lectures John Pickering Feb 20

This afternoon I have heard presentations from seven former students of the Christchurch Med School (University of Otago Christchurch), almost all now Professors.  It has been fascinaying and moving.

1.00 – 1.25 Professor Vicky Cameron, Cardiovascular risk factors in Maori and non- Maori communities: Strategies for improved clinical management’ 

Fascinating comparision between an urban Maori, Rural Maori and urban non-Maori cohort.  Despite  good access to primary care  and little access to fast food outlets urban Maori were exhibiting the highest risk factors.

1.25 – 1.45 Mr Tim Eglinton, ‘Starting at the bottom and working up: Perianal Crohn’s Disease in Canterbury’

Canterbury has one of the highestrates of Chrons disease in the world!

1.45 – 2.15 Dr Quentin Durward, ‘The Crash of United Flight 232 in Sioux City, Iowa, July 19 1989: Community and Medical Response to a Mass- Casualty Commercial Airliner Disaster’

Very moving account of dealin with an air disaster.  Fortunately there was a great plan in place.

2.15 – 2.45 Professor Michael Ardagh, ‘After the dust settles – researching the health implications of seismic events’

Also very moving.  Prof Ardagh is head of the Emergency Department here.  He talked about the response to the earthquake.  Again the importance of a plan can not be overesimated.     Who knew that during those first few hours the blood bank was still processing requests while ankle deep in water, suffering power outages, in a basement of a very shakey multistory building, all at the same time as not knowing about  their own families?  More heroes unsung!

 

Afternoon sessions

Come tomorrow.

Chair: Professor Lisa Stamp

3.30 – 4.00 Professor Brian Darlow, ‘From small to

big – clinical research in newborn medicine’

4.00 – 4.30 Professor Rob Walker, ‘Nephrology: Ross Bailey – Drugs and the Kidney’

4.30 – 5.00 Professor Bridget Robinson, ‘Keeping Cancer Research Close to the Patient’ 

Tagged: health, university of otago

1300 John Pickering Feb 20

Today’s number brought to you by Funeral Directors of New Zealand.

 

1300

 

Kidney Attack (aka Acute Kidney Injury) is responsible for at least 1300 deaths a year in New Zealand.  It used to be said that people died with Acute Kidney Injury rather than of Acute Kidney Injury.  The paradigm has shifted in the last few years.  Now it is recognised that an acute attack on the kidneys is a killer all by itself.  Of course, the attack is still most often precipitated by another event – heart attack, serious infection, cardiac surgery etc etc etc.

How did I come up with 1300?

A comprehensive study of nearly 20,000 hospital admissions showed that there was a 4.1 times increase in risk of death in hospital for those with Kidney Attack compared to those without.  The Ministry of Health in New Zealand do not report hospital mortality data, but a very helpful MOH information analyst, Chris Lewis (thanks Chris), dug out some numbers for me.  There were 7582 patients out of 548,965 discharges from public hospitals in 2011/12 who were “Discharged Dead”, Died in the emergency department, or Discharged for organ donation.  This does not necessarily capture all deaths (eg Private Hospitals are not included).  However, it gives me enough to go on using the proportion who died overall, the increased odds of death with Kidney Attack (4.1), the estimated number of Kidney Attack patients (30,000), and a little bit of math. The result is at least 1300 Kidney Attack deaths.

 

Tagged: Acute Kidney Injury, AKI, death, Kidney Attack, Mortality, World Kidney Day

The Measure of Māori Wellness John Pickering Feb 18

Winston Peters is employing classic diversion techniques in order to avoid answering questions as to why he hasn’t sacked Mr Prosser – in this case it is an attack on the associate Ministry of Health about funding of traditional Māori healing (rongoā Māori) through Whanau Ora (apparently $1.9M worth).  He claims that there is no measure of efficacy and that even the numbers of recipients of the service are unknown.

If he is correct, then he has a point.  No Ministry of Health funding should be spent without either good evidence or a good program to gather evidence (presumably first as a pilot scheme and then with continued monitoring).

There is framework by which such evidence could be gathered.  The  framework was the culmination of a research project which developed outcome measures for rongoā Māori based on Māori concepts of wellness.

The Ngā Tohu o te Ora (signs of wellness) research project was developed to investigate outcomes associated with rongoā Māori, in order that this traditional practice might enjoy increased support as a funded service. The primary aims were to:

  1.  Identify wellness outcome measures used by traditional Māori healers, and

  2. Develop and test a framework of traditional Māori wellness outcome measures.

I am no position to judge how good the research was and while the reason for developing the framework has an obvious bias (in order that….increased support as a funded service), I would still expect that this framework at least has been employed to assess the efficacy of the services provided by Whanau Ora.  Has it?  If not this framework, then what?

If there has been no measure of efficacy of the Whanau Ora program, then I wonder what other programs the Ministry of Health has funded without any monitoring?

As long as this is not another Winston Peters beat up, then it may be the tip of the iceberg and an opportunity for evidence based medicine to be pushed to the fore in the MOH.

Tagged: Evidence Based Medicine, Maori, Rongoa, Whanau Ora, Winston Peters

The Measure of Māori Wellness John Pickering Feb 18

Winston Peters is employing classic diversion techniques in order to avoid answering questions as to why he hasn’t sacked Mr Prosser – in this case it is an attack on the associate Ministry of Health about funding of traditional Māori healing (rongoā Māori) through Whanau Ora (apparently $1.9M worth).  He claims that there is no measure of efficacy and that even the numbers of recipients of the service are unknown.

If he is correct, then he has a point.  No Ministry of Health funding should be spent without either good evidence or a good program to gather evidence (presumably first as a pilot scheme and then with continued monitoring).

There is framework by which such evidence could be gathered.  The  framework was the culmination of a research project which developed outcome measures for rongoā Māori based on Māori concepts of wellness.

The Ngā Tohu o te Ora (signs of wellness) research project was developed to investigate outcomes associated with rongoā Māori, in order that this traditional practice might enjoy increased support as a funded service. The primary aims were to:

  1.  Identify wellness outcome measures used by traditional Māori healers, and

  2. Develop and test a framework of traditional Māori wellness outcome measures.

I am no position to judge how good the research was and while the reason for developing the framework has an obvious bias (in order that….increased support as a funded service), I would still expect that this framework at least has been employed to assess the efficacy of the services provided by Whanau Ora.  Has it?  If not this framework, then what?

If there has been no measure of efficacy of the Whanau Ora program, then I wonder what other programs the Ministry of Health has funded without any monitoring?

As long as this is not another Winston Peters beat up, then it may be the tip of the iceberg and an opportunity for evidence based medicine to be pushed to the fore in the MOH.

Tagged: Evidence Based Medicine, Maori, Rongoa, Whanau Ora, Winston Peters

Back to school Mr Prosser John Pickering Feb 13

I once stood as a parliamentary candidate in the Waimakariri electorate as did Richard Prosser.  I got more votes than he did, albeit a few years earlier (Compare electoral results 2011 & 2005)).  If I were to appeal to the same level of logical reasoning as does Mr Prosser,  more votes makes me more of a politician than he.

Mr Prosser’s logic goes thus:

Terrorists are probably Male, 18 to 35

Terrorists are probably Muslim

Terrorists probably “look” Muslim (whatever that means)

Victims are probably Western Airlines

Therefore ban Male, 18-35, Muslim or Muslim-looking males from flights on Western airlines.

This is exactly why we need critical thinking programs in schools.  Indeed, all parliamentarians should have to pass a course in critical thinking before they are permitted to take up their roles.  Consider these Mr Prosser:

In New Zealand terrorists are either Male or Female

In New Zealand terrorists are French

In New Zealand terrorists are military

In New Zealand terrorism takes place on boats

Therefore ban all French military personnel from boats in New Zealand.

and

Rapists are probably Male, older than 18

Rapists are most likely known to their victim

Rape victims are probably female

Therefore ban all males known by females from being in the same room as them.

The good news is that this would keep Mr Prosser out of Parliament if only one female MP says they know him.  After what he has said, this cannot be taken for granted.

What may keep Mr Prosser out of Parliament is if Mr Peters fires him.  So far he has failed to even suggest Mr Prosser make an apology.  In my book this makes Mr Peters complicit to racism of the most ignorant insulting kind.  Perhaps if after a beard growing Movember he were hauled from a flight he would change his mind.

Sources: One News & Daily Telegraph, with artistic license by Dr JP

Sources: One News & Daily Telegraph, with artistic license by Dr JP

In the meantime, Mr Prosser has failed Critical Thinking 101 and should return to school this week where I very much hope teachers are taking the opportunity to teach not merely how to respect others, but how to think critically.

Tagged: Critical Thinking, racism, Richard Prosser, Winston Peters

30,000 John Pickering Feb 08

Today’s number brought to you by <You could have your name here, contact the blog writer to arrange sponsorship>

30,000 – the number of Kidney Attacks in New Zealand each year.

30000

Where does this number come from?

Research in other parts of the world has Kidney Attack, or Acute Kidney Injury, at ~5% of all hospital admissions.  Estimates range from 2% to >9%.  5% is the generally accepted incidence.  New Zealand has more than 1.1 million hospital admissions a year, with 410,000 of them day cases.  5% of the 690,000 longer stays is 34,500.  30,000 is, therefore, a conservative estimate.  The NZ health stats don’t report these numbers because they are not collected.  They are not collected because nearly always the cause for hospital admission is something else – heart attack, infection etc.  These “something elses” all can cause Kidney Attack.   Kidney Attack raises the chances of dying in hospital 4 fold.

I’d like to find the NZ incidence of Kidney Attack instead of relying on estimates based on overseas numbers.  In particular, I’d like to see if there are any differences related to ethnicity.  I’m searching for funding to do this.

Tagged: Acute Kidney Injury, AKI, Kidney, Kidney Attack, World Kidney Day

How many times do you wash your blood each day? John Pickering Feb 01

Stop Kidney Attack.  See this great short video from last year’s World Kidney Day as to why it is so very very important to look after your kidneys. Or as Fred Dagg may sing “If it weren’t for your kidneys, where would you be? You’d be in the hospital or infirmary.”



Tagged: Acute Kidney Injury, Blood, Chronic Kidney Disease, Kidney, Kidney Attack, World Kidney Day

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