Implementation and evaluation of a rural general practice assessment pathway for possible cardiac chest pain using point-of-care troponin testing: a pilot study.

Objectives: To assess the feasibility and acceptability, and additionally to preliminarily evaluate, the effectiveness and safety of an accelerated diagnostic chest pain pathway in rural general practice using point-of-care troponin to identify patients at low risk of acute myocardial infarction, avoiding unnecessary patient transfer to hospital and enabling early discharge home.

Design: A prospective observational pilot evaluation.

Setting: Twelve rural general (family) practices in the Midlands region of New Zealand.

A prospective multi-centre study assessing the safety and effectiveness following the implementation of an accelerated chest pain pathway using point-of-care troponin for use in New Zealand rural hospital and primary care settings.

Aims: Most rural hospitals and general practices in New Zealand (NZ) are reliant on point-of-care troponin. A rural accelerated chest pain pathway (RACPP), combining an electrocardiogram (ECG), a structured risk score (Emergency Department Assessment of Chest Pain Score), and serial point-of-care troponin, was designed for use in rural hospital and primary care settings across NZ. The aim of this study was to evaluate the safety and effectiveness of the RACPP.

A typical presentation of type B insulin resistance syndrome with isolated hypoglycaemia and suppressed insulin.

Type B insulin resistance syndrome is a rare autoimmune disorder affecting glucose homeostasis characterised by the presence of serum autoantibodies to the insulin receptor. Typically, these patients present with severe insulin resistance although a mixed hyperglycaemic and hypoglycaemic phenotype may also occur, as can an exceptionally rare isolated hypoglycaemia presentation. The classic biochemical pattern comprises elevated insulin levels despite significant hypoglycaemia.

Study protocol for an observational study to evaluate an accelerated chest pain pathway using point-of-care troponin in New Zealand rural and primary care populations.

INTRODUCTION Accelerated diagnostic chest pain pathways are used widely in urban New Zealand hospitals. These pathways use laboratory-based troponin assays with good analytical precision. Widespread implementation has not occurred in many of New Zealand's rural hospitals and general practices as they are reliant on point-of-care troponin assays, which are less sensitive and precise.

How comparable are total human chorionic gonadotropin (hCGt) tumour markers assays?

Background Total human chorionic gonadotropin (hCGt) tumour marker testing is regarded as an "off label" application for most commercial methods. We compared four assays in patients with a hCGt tumour marker request. We hypothesised that regression slopes would be altered and that outliers would be more common with tumour marker than with pregnancy samples if the detection of malignancy associated hCG molecular forms differed amongst assays.

Paraprotein Sample Exchange in Australia and New Zealand - 2018.

Quantification of co-migrating paraproteins in the beta-region presents an ongoing challenge for laboratories performing serum protein electrophoresis. The between-laboratory variation may impact patient care if the patient uses different pathology services during plasma cell dyscrasia monitoring. To identify the practical difficulties and determine the extent of agreement in the reporting of beta-migrating paraproteins in Australia and New Zealand (NZ), sample exchanges were conducted in five Australian states and in NZ in early 2018.

ICare-ACS (Improving Care Processes for Patients With Suspected Acute Coronary Syndrome): A Study of Cross-System Implementation of a National Clinical Pathway.

Background: Efforts to safely reduce length of stay for emergency department patients with symptoms suggestive of acute coronary syndrome (ACS) have had mixed success. Few system-wide efforts affecting multiple hospital emergency departments have ever been evaluated. We evaluated the effectiveness of a nationwide implementation of clinical pathways for potential ACS in disparate hospitals.

A note on marginalization of regression parameters from mixed models of binary outcomes.

This article discusses marginalization of the regression parameters in mixed models for correlated binary outcomes. As is well known, the regression parameters in such models have the "subject-specific" (SS) or conditional interpretation, in contrast to the "population-averaged" (PA) or marginal estimates that represent the unconditional covariate effects. We describe an approach using numerical quadrature to obtain PA estimates from their SS counterparts in models with multiple random effects.

Factitious Graves' Disease Due to Biotin Immunoassay Interference-A Case and Review of the Literature.

Context: Biotin (vitamin B7) is an essential co-factor for four carboxylases involved in fatty acid metabolism, leucine degradation, and gluconeogenesis. The recommended daily intake (RDI) of biotin is approximately 30 μg per day. Low-moderate dose biotin is a common component of multivitamin preparations, and high-dose biotin (10 000 times RDI) has been reported to improve clinical outcomes and quality of life in patients with progressive multiple sclerosis.

Vitamin D status of psychiatric inpatients in New Zealand's Waikato region.

Background: Vitamin D deficiency is widespread in New Zealand, confers multiple health risks, and may be particularly common among people with psychiatric illness. We studied vitamin D status in an unselected sample of adult psychiatric inpatients in Hamilton (latitude 37.5 S) during late winter.

Total hCG tests.

Introduction: There are 12 types of automated total hCG tests sold today, the Abbott Architect, Abbott AxSym, the Beckman Access 2. Beckman DxI 800, the Ortho Vitros EciQ, Roche Elecsys hCG+β, Siemens ACS180, Siemens Centaur, Siemens Dimension, Siemens Immulite and Siemens Stratus, and the Tosoh A1A. All tests claim to be total hCG tests but do not define what total means.

Advances in analysis of longitudinal data.

In this review, we explore recent developments in the area of linear and nonlinear generalized mixed-effects regression models and various alternatives, including generalized estimating equations for analysis of longitudinal data. Methods are described for continuous and normally distributed as well as categorical (binary, ordinal, nominal) and count (Poisson) variables. Extensions of the model to three and four levels of clustering, multivariate outcomes, and incorporation of design weights are also described.

Inappropriate trace element testing in the Auckland region.

Aim: To understand recent changes in trace element test usage in the Auckland region of New Zealand.

Methods: Laboratory records of trace element tests between 2004 and 2008 were analysed. A questionnaire was sent to a frequent requestor group to elicit reasons for requesting trace element tests.

Structural Equation Modeling of Multivariate Time Series.

The covariance structure of a vector autoregressive process with moving average residuals (VARMA) is derived. It differs from other available expressions for the covariance function of a stationary VARMA process and is compatible with current structural equation methodology. Structural equation modeling programs, such as LISREL, may therefore be employed to fit the model.

Fitting Partially Nonlinear Random Coefficient Models as SEMs.

The nonlinear random coefficient model has become increasingly popular as a method for describing individual differences in longitudinal research. Although promising, the nonlinear model it is not utilized as often as it might be because software options are still somewhat limited. In this article we show that a specialized version of the model can be fit to data using SEM software.

Mental retardation and ataxia due to normotriglyceridemic hypobetalipoproteinemia.

A 12-year-old boy with mental retardation, obesity, ataxia, and visual impairment was shown to have normal fasting plasma triglyceride but low cholesterol and vitamin E levels. Investigations indicated that he was compound heterozygous for two mutations in the apolipoprotein B gene (APOB), resulting in a failure to express apolipoprotein B-100, yet retain apolipoprotein B-48 production. The proband therefore was able to form chylomicrons, but not a low-density lipoprotein capable of receptor-mediated endocytosis.

A Version of Quadratic Regression with Interpretable Parameters.

The quadratic regression model is popular and effective in describing a wide variety of data, but it is based on a function whose parameters are not easy to interpret. We suggest an alternative form of the quadratic model that has the same expectation function, but also has the useful feature that its parameters are interpretable. Examples are provided of a simple regression problem and also of a nonlinear mixed-effects model.