Dilatation of the abdominal aorta (aneurysm formation) is a significant cause of community-based death for men aged 65 years and over. The mortality of a community-based aortic aneurysm rupture is approximately 90%, while the mortality of planned surgery for aortic aneurysms is <6%. The risk of aneurysm rupture is related to the diameter of the aorta, with larger aneurysms having a greater risk of rupture. At a diameter of 55mm, the risk of surgical repair is less than the risk of aneurysm-related death and it is at this aortic size that surgery is indicated. To identify when patients reach this 55mm threshold, we place them in an ultrasound surveillance programme. This paper demonstrates that although robust surveillance was carried out at Christchurch Hospital during the 5 years of the study, delays occurred when patients reached the surgical threshold of 55mm, which may have caused aneurysm-related deaths. The paper also indicates that although women represent only 25% of patients with aortic aneurysms, a 55mm threshold may be inappropriate for them and further evidence of a female threshold is needed.

We audited the advice and documentation given at Christchurch Public Hospital to patients (and their families) to see whether the fact that aneurysm disease may be heriditary in some cases was satisfactorily conveyed to those patients. Of the 79 patients included in the study, 20 (25%) underwent endovascular AAA repair (EVAR) and 59 (75%) underwent open AAA repair. Notes of only 19 out of 79 of the patients contained thorough documentation of the advice offered regarding family history of AAA. This study has identified deficiencies in the documentation of the counselling process regarding the occasional hereditary nature of AAAs. The results of this audit and the evidence outlined in the discussion will hopefully improve our management of AAA patients and their relatives.

Abdominal aorta is an artery in the abdomen which can dilate (swell) causing an abdominal aortic aneurysm (AAA); such aneurysms can burst causing death. They can be treated with an open abdominal operation or via (the newer) percutaneous technique—i.e. placing an intra-arterial stent to exclude the aneurysm (endoluminal stent graft). This newer technique is under scrutiny, as the open abdominal operation is tried and tested. This paper looks at the endoluminal stent graft experience in Middlemore Hospital between 1998–2005. The audited data have 100% capture and represent tertiary centre experience, but are relatively small in number. However the data show good results using this newer technique for treatment of AAA at Middlemore Hospital.

International evidence indicates that the use of complementary and alternative medicines (CAM) is increasing, with substantial rates of CAM-use found in paediatric hospital-based populations (Australia 51%, Wales 41%). Increasing numbers of cases of adverse effects, particularly if CAM is used in combination with prescribed medicines, have also been noted. Little is known about the use of CAM in New Zealand children attending a general practice compared to children attending a paediatric outpatient clinic where use may be higher. This study compared these two groups of children by interviewing parents to examine whether there are differences in the use of CAM, in disclosing CAM-use to their children’s doctor, and in obtaining information about CAM. Contrary to expectations, this study found that there were no significant differences in the two sampled populations. Compared to international paediatric populations, this study found the prevalence of lifetime CAM-use in New Zealand was high (70%) and that a greater number of parents (77%) did not disclose CAM-use with their children’s doctor. The majority reported that this was unintentional (87%). Parents who used CAM themselves were four times more likely to use CAM with their children. Results suggest that all prescribers need to explicitly ask parents about CAM-use with their children, particularly those who use CAM themselves.

The aim of this study was to determine the extent and nature of extemporaneous compounding of liquid preparations in a sample of New Zealand hospitals. Extemporaneous compounding is the reformulation of existing dosage forms into a form that is more appropriate for the patient; this often involves the reformulation of a tablet into a liquid form, for example, to assist with swallowing for paediatric and elderly patients. Pharmacists are the health professionals in New Zealand who may compound medicines, and preparing pharmaceutical products is one of the seven Competence Standards required of entry-level pharmacists. The findings show that there is a range of extemporaneous compounding that occurs in New Zealand hospitals. Suspensions were the most frequently compounded liquid preparation and omeprazole was the drug most frequently reformulated.

Substantial evidence exists for the use of drug prophylaxis to prevent deep vein thrombosis (DVT) and pulmonary embolism (PE) in hospital inpatients. Despite this, many patients who would benefit from prophylaxis do not receive this treatment. We implemented an education programme to promote the use of the prophylactic drug enoxaparin. We used a strategy of lectures, a bulletin, and pre-printed stickers placed in drug charts. To assess changes in practice, we undertook an audit and showed that a substantial positive impact was made to prescribing of enoxaparin prophylaxis (in those eligible for treatment). Further study is required to determine whether this benefit can be sustained. Deep vein thrombosis: Blood clot within the leg. Pulmonary embolus: Blood clot with the lungs. Generally originates from the leg and travels to the lungs via the blood returning to the heart. Enoxaparin: A blood thinning treatment, given as an injection under the skin. Prophylaxis: Preventative treatment which may be drug-based or non drug-based.