A systematic review of leadership training for medical students
Leadership is increasingly being recognised as an essential requirement for doctors. Many medical schools are in the process of developing formal leadership training programmes. A wide range of leadership curricula have shown some degree of effectiveness, including short interventions, but few studies have measured effectiveness at the system and patient levels. Further research is needed investigating objective and downstream outcomes, and use of standard frameworks for evaluation will facilitate effective comparison of initiatives.
Rates of unsuspected thyroid cancer in multinodular thyroid disease
In this paper we assessed the rates of thyroid cancer identified by the pathologist after surgical removal of the thyroid gland when cancer was not suspected prior to surgery. Removal of the thyroid was performed for a reason other than the suspicion of cancer such as pressure symptoms from a large gland (goitre) or overactivity of the gland. Of the group with normal thyroid hormone levels, 8% had an incidental thyroid cancer and of those with an overactive thyroid gland, 10% of patients has a thyroid cancer identified on routine pathological assessment of the specimen. Most of these incidental cancers were small and of a type which would be expected to be unlikely to alter survival even if diagnosis had been delayed.
The effect of trampoline parks on presentations to the Christchurch Emergency Department
Christchurch saw a significant increase in trampoline-related injuries after the opening of two new parks. These injuries involved an older group of children, affected predominantly the lower limbs and were more severe than those reported from the use of domestic trampolines. Consistent with past research, the trampoline park allowing multiple users had a higher proportion of presentations and more injuries requiring operative intervention.
Increasing rates of people identifying as transgender presenting to Endocrine Services in the Wellington region
Before 2000 there were only a few people referred to the Wellington Endocrine clinic for gender reassignment treatment each year. The numbers increased a little in the first decade of this century, but have increased further from 2010 and 2011—from about 20 cases each year to 91 in 2016. As treatment during a change in gender identity involves psychological and counselling support, hormone therapy and possibly reassignment surgery, medical services should plan to provide facilities to meet this increase in need.
The burden of cancer in 25–29 year olds in New Zealand: a case for a wider adolescent and young adult age range?
Due to our small population and geographic spread, New Zealand faces unique challenges in providing high-quality, comprehensive adolescent and young adult (AYA) cancer services. A 2000–2009 15–24-year analysis showed poorer survival for Māori and Pacific Peoples and for AYA diagnosed with certain cancers such as bone tumours. This has led to a major national focus to improve the outcomes for our AYA population, including the establishment of the AYA Cancer Network Aotearoa in 2013 and the release of the AYA Standards of Care in May 2017. In this paper we report a comprehensive analysis of the incidence and outcome for 25–29 year-old cancer patients. In addition, this paper introduces the AYA Cancer Network and provides the New Zealand medical community with an overview of some the current issues in AYA oncology, including the lack of a clear AYA age range and barriers to increasing clinical trial participation rates for this at-risk population.
Compassion from a palliative care perspective
Compassion lies at the heart of good medical care, particularly for the most vulnerable end-of-life patients. However, even though compassion is crucial and central to medical care, it is poorly researched. Our goal was to understand patients’ experiences of compassion and lack of compassion so that we can inform doctors and nurses what compassion is and is not from a dying patient’s perspective. We found that though compassion is so valuable and treasured by patients, it is not that complicated and in fact is “cheap”, meaning it does not take much time and effort from the clinicians. Dying patients see compassion as clinicians connecting with them, talking to them in a way that can be understood, treating them with respect, showing some interest in them and having a positive presence for them.