Direct Transport to PCI-capable Hospitals After Out-of-hospital Cardiac Arrest in New Zealand: Inequities and Outcomes

BACKGROUND: It is widely accepted that survival from OHCA may be improved through direct transfer of patients to hospitals with percutaneous coronary intervention (PCI) capability. However, within the New Zealand healthcare system there is limited evidence available to support this. We aimed to compare patient characteristics and outcomes following an out-of-hospital cardiac arrest between those patients transported to hospitals with or without PCI-capability within New Zealand. METHOD: A retrospective cohort study was conducted using data from the St John New Zealand OHCA registry for adults treated for an out-of-hospital cardiac arrest of presumed cardiac aetiology between 1 October 2013 and 31 October 2018. Population characteristics were investigated using a Chi-Square analysis. Binary logistic regression modelling was used to investigate outcome differences in survival at 30 days post-event according to receiving hospital PCI-capability. RESULTS: The study included 1750 patients who were transported to hospital following an OHCA. A significantly lower proportion of patients over 65 years (49.9%) were conveyed to hospitals with PCI-capability compared to younger aged patients (15-44 years (52.1%) and 45-64 years (59.7%) (p < 0.001). When ethnic groups were compared, Māori (32.9%) had the lowest proportion transported to PCI-capable hospitals, followed by European (55.6%) then Pacific Peoples (86.2%) (p < 0.001). A lower proportion of patients located rurally (34.7%) were transported to hospitals with PCI-capability compared to patients in an urban location (59.1%) (p < 0.001). Thirty-day survival was higher in patients transported to hospitals with PCI-capability (adjusted OR 1.285, 95%CI (1.01-1.63), p = 0.04). CONCLUSIONS: Patient characteristic differences indicate that inequities in healthcare may exist in New Zealand related to age, ethnic group, and rurality. Thirty-day survival was significantly increased in patients conveyed directly to a hospital with PCI-capability

Fostering a Research Culture in Paramedicine: Selected Proceedings From the 2011–2013 Paramedic Research Forum at Auckland University of Technology

These are selected posters from the Auckland University of Technology Paramedic Research Forums in 2011-2013

Financial stress and strain associated with terminal cancer:a review of the evidence

Financial circumstances are a significant influence on the quality of life for older people and may be important to health and wellbeing at the end of life. The aim of this study is to review the evidence for the existence and consequences of financial stress and strain at the end of life for people dying with cancer. We conducted a systematic search of four electronic databases for studies, providing data on illness-related financial burden (stress), or perception of financial hardship (strain), from patients with terminal cancer or their caregivers. Twenty-four papers were identified from 21 studies published in English between 1980 and 2006, the majority (14) of cross-sectional design. Financial stress was reported in all 13 studies from the USA (median 33%, range 10-66%), but only four sought measures of financial strain. In the USA, specific social consequences, such as moving house or change in employment to cope with caregiving, were reported in four of these studies; one of these also noted changes in treatment choices and avoidance of care for other family members. In studies from outside the USA, there is a dearth of data on financial stresses and the consequences of this for the household, despite widespread reporting of financial strain. To fill a gap in our understanding and improve holistic palliative care, researchers need to ask the questions about the consequences of financial stresses and strain for the health and wellbeing of the household

Measuring stroke and transient ischemic attack burden in New Zealand: Protocol for the fifth Auckland Regional Community Stroke Study (ARCOS V)

Aim: The goal of this paper is to provide a protocol for conducting a fifth population-based Auckland Regional Community Stroke study (ARCOS V) in New Zealand. Methods and Discussion: In this study, for the first time globally, (1) stroke and TIA burden will be determined using the currently used clinical and tissue-based definition of stroke, in addition to the WHO clinical classifications of stroke used in all previous ARCOS studies, as well as more advanced criteria recently suggested for an “ideal” population-based stroke incidence and outcomes study; and (2) age, sex, and ethnic-specific trends in stroke incidence and outcomes will be determined over the last four decades, including changes in the incidence of acute cerebrovascular events over the last decade. Furthermore, information at four time points over a 40-year period will allow the assessment of effects of recent changes such as implementation of the FAST campaign, ambulance pre-notification, and endovascular treatment. This will enable more accurate projections for health service planning and delivery. Conclusion: The methods of this study will provide a foundation for future similar population-based studies in other countries and populations

Measuring stroke and transient ischemic attack burden in New Zealand: protocol for the fifth Auckland Regional Community Stroke Study (ARCOS V)

Aim: The goal of this paper is to provide a protocol for conducting a fifth population-based Auckland Regional Community Stroke study (ARCOS V) in New Zealand. Methods and Discussion: In this study, for the first time globally, (1) stroke and TIA burden will be determined using the currently used clinical and tissue-based definition of stroke, in addition to the WHO clinical classifications of stroke used in all previous ARCOS studies, as well as more advanced criteria recently suggested for an “ideal” population-based stroke incidence and outcomes study; and (2) age, sex, and ethnic-specific trends in stroke incidence and outcomes will be determined over the last four decades, including changes in the incidence of acute cerebrovascular events over the last decade. Furthermore, information at four time points over a 40-year period will allow the assessment of effects of recent changes such as implementation of the FAST campaign, ambulance pre-notification, and endovascular treatment. This will enable more accurate projections for health service planning and delivery. Conclusion: The methods of this study will provide a foundation for future similar population-based studies in other countries and populations.</p