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Aotearoa New Zealand's population is ageing. Increasing life expectancy is accompanied by increases in prevalence of Alzheimer's Disease (AD) and ageing-related disorders. The multicentre Dementia Prevention Research Clinic longitudinal study aims to improve understanding of AD and dementia in Aotearoa, in order to develop interventions that delay or prevent progression to dementia. Comprising research clinics in Auckland, Christchurch and Dunedin, this multi-disciplinary study involves community participants who undergo biennial investigations informed by international protocols and best practice: clinical, neuropsychological, neuroimaging, lifestyle evaluations, APOE genotyping, blood collection and processing. A key research objective is to identify a 'biomarker signature' that predicts progression from mild cognitive impairment to AD. Candidate biomarkers include: blood proteins and microRNAs, genetic, neuroimaging and neuropsychological markers, health, cultural, lifestyle, sensory and psychosocial factors. We are examining a range of mechanisms underlying the progression of AD pathology (e.g. faulty blood–brain barrier, excess parenchymal iron, vascular dysregulation). This paper will outline key aspects of the Dementia Prevention Research Clinic's research, provide an overview of data collection, and a summary of 266 participants recruited to date. The national outreach of the clinics is a strength; the heart of the Dementia Prevention Research Clinics are its people. [ABSTRACT FROM AUTHOR]

• Radiotherapy in a specialised sarcoma centre is associated with a lower rate of major postoperative wound complications. • Radiotherapy may be a contributing factor in the improved oncologic outcomes when patients undergo treatment at a sarcoma centre. Patients with sarcoma are best managed at specialised sarcoma centres as supported by published literature. Optimal management requires multidisciplinary team input to formulate the diagnosis and treatment sequencing taking into consideration multiple clinical and pathologic factors. This systematic review aimed to evaluate the impact on outcomes of radiotherapy at specialised sarcoma centres. A systematic review was conducted using the population, intervention, comparison and outcome model. A literature search was performed using Medline, Embase, Cochrane Central databases for publications from 1990 to February 2022 that evaluated the local control, survival and toxicity of radiotherapy at specialised sarcoma centres. A total of 21 studies were included (17 cancer registry studies, four retrospective comparative studies). Four studies reported the local recurrence endpoint when radiotherapy was part of limb conservation treatment and showed better conformity to clinical practice guidelines and an improved local recurrence free rate when radiotherapy treatment is supported through, but may not be necessarily delivered at a specialised sarcoma centres. Only one retrospective study analysed toxicity specifically and demonstrated that patients who received preoperative radiotherapy at community centres compared to radiotherapy at a specialised sarcoma centre were more likely to develop a major wound complication. Fourteen studies reported overall survival, and 12 of these showed significantly better 5-year overall survival for patients managed at specialised sarcoma centres, however the specific impact of radiotherapy delivered at sarcoma centres could not be determined. In conclusion, patients with sarcoma should be managed through specialised sarcoma centres for better oncological outcomes. Radiotherapy in specialised sarcoma centre is associated with a lower rate of wound complications and may contribute to improved oncological outcomes as part of the limb conservation treatment at a specialised sarcoma centre. [ABSTRACT FROM AUTHOR]

Humans have relied on coastal resources for centuries. However, current growth in population and increased accessibility of coastal resources through technology have resulted in overcrowded and often conflicted spaces. The recent global move towards development of national blue economy strategies further highlights the increased focus on coastal resources to address a broad range of blue growth industries. The need to manage sustainable development and future exploitation of both over-utilised and emergent coastal resources is both a political and environmental complexity. To address this complexity, we draw on the perspectives of a multi-disciplinary team, utilising two in depth exemplary case studies in New Zealand and within the Myanmar Delta Landscape, to showcase barriers, pathways and actions that facilitate a move from Business as Usual (BAU) to a future aligned with the Sustainable Development Goals (SDGs) and the UN International Decade of Ocean Science for Sustainable Development 2021–2030. We provide key recommendations to guide interest groups, and nations globally, towards sustainable utilisation, conservation and preservation of their marine environments in a fair and equitable way, and in collaboration with those who directly rely upon coastal ecosystems. We envision a sustainable future driven by conflict mitigation and resolution, where: Change is motivated and facilitated Coastal ecosystems are co-managed by multiple reliant groups Networks that maintain and enhance biodiversity are implemented Decision-making is equitable and based on ecosystem services Knowledge of the marine realm is strengthened—'mapping the ocean of life' The interests of diverse user groups are balanced with a fair distribution of benefits [ABSTRACT FROM AUTHOR]

Background: With growing global prevalence of diabetes mellitus, diabetes-related foot disease (DFD) is contributing significantly to disease burden. As more healthcare resources are being dedicated to the management of DFD, service design and delivery is being scrutinised. Through a national survey, this study aimed to investigate the current characteristics of services which treat patients with DFD in Australia. Methods: An online survey was distributed to all 195 Australian members of the Australian and New Zealand Society for Vascular Surgery investigating aspects of DFD management in each member's institution. Results: From the survey, 52 responses were received (26.7%). A multidisciplinary diabetes foot unit (MDFU) was available in more than half of respondent's institutions, most of which were tertiary hospitals. The common components of MDFU were identified as podiatrists, endocrinologists, vascular surgeons and infectious disease physicians. Many respondents identified vascular surgery as being the primary admitting specialty for DFD patients that require hospitalisation (33/52, 63.5%). This finding was consistent even in centres with MDFU clinics. Less than one third of MDFUs had independent admission rights. Conclusions: The present study suggests that many tertiary centres in Australia provide their diabetic foot service in a multidisciplinary environment however their composition and function remain heterogeneous. These findings provide an opportunity to evaluate current practice and, to initiate strategies aimed to improve outcomes of patients with DFD. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Obesity is now widely regarded as the main contributor to poor health globally, overtaking tobacco as the leading potentially modifiable risk to health. Community pharmacists are delivering an increasing number of extended services and are potentially well placed to contribute to obesity management strategies. No studies to date have investigated the views of community pharmacists in New Zealand about their role in weight management. AIM: To explore the views of community pharmacists in one region of New Zealand about their role in weight management, including the perceived barriers and facilitators to their involvement. METHODS: Qualitative, face-to-face, semi-structured interviews were undertaken with 11 community pharmacists from the Greater Wellington region. Interviews were transcribed verbatim and analysed thematically using an inductive approach. RESULTS: Four key themes were identified from data analysis. These were: (i) perceptions of obesity; (ii) perceptions of weight management treatment options; (iii) the unique position of the community pharmacist; and (iv) barriers to involvement. The main barriers described included: (i) a lack of time and remuneration; (ii) the absence of an appropriate space within the pharmacy to discuss weight-related matters; (iii) and a lack of awareness of who to contact for specialist support. DISCUSSION: Community pharmacists in Greater Wellington believe that they have a distinct role in their local community and can contribute to a multidisciplinary approach to reduce levels of obesity. Further work is required to determine the most appropriate role for community pharmacy in weight management and the training needs for pharmacy staff to optimally fulfil this role. [ABSTRACT FROM AUTHOR]

Introduction There is limited evidence whether decisions of Thoracic Multidisciplinary Meetings ( TMDMs) are reflected in the treatment lung cancer patients actually receive. Aims were to determine concordance between TMDM recommendations for radiotherapy ( RT) and actual RT administered and to compare cases that received RT that were referred or not referred from TMDMs. Method A retrospective review of demographic and clinical data for all lung cancer cases within the Auckland- Northland region referred for RT from TMDMs ( January- June 2009) and all cases that received RT but were not referred from TMDMs ( January- August 2009). Results Of 110 cases referred for RT from TMDMs, 86 (78%) were offered RT (76 with the same treatment intent) and 78 (71%) received RT. Ten (9%) cases were deemed unsuitable for RT; 7 (6%) deteriorated; 4 (4%) declined or did not attend; 3% other. Fifty-one other cases received RT without TMDM presentation. Cases with remote domicile or recurrent disease were significantly less likely to have been presented at TMDMs. TMDM presentation did not significantly increase transit time to RT. The proportion of RT cases referred from TMDMs had increased substantially since 2004. Conclusion The concordance between TMDM recommendations for RT and both the RT administered and the intent of treatment suggests a useful role for TMDMs. Concordance could be increased by improving RT timeliness and improved education of other disciplines and patients regarding the role of RT. Strategies to increase presentation at TMDM include attention to geographically isolated groups. [ABSTRACT FROM AUTHOR]

Background: Internet-based treatment programs present a solution for providing access to pain management for those unable to access clinic-based multidisciplinary pain programs. Attrition from internet interventions is a common issue. Clinician-supported guidance can be an important feature in web-based interventions; however, the optimal level of therapist guidance and expertise required to improve adherence remains unclear.Objective: The aim of this study is to evaluate whether augmenting the existing Reboot Online program with telephone support by a clinician improves program adherence and effectiveness compared with the web-based program alone.Methods: A 2-armed, CONSORT (Consolidated Standards of Reporting Trials)-compliant, registered randomized controlled trial with one-to-one group allocation was conducted. It compared a web-based multidisciplinary pain management program, Reboot Online, combined with telephone support (n=44) with Reboot Online alone (n=45) as the control group. Participants were recruited through web-based social media and the This Way Up service provider network. The primary outcome for this study was adherence to the Reboot Online program. Adherence was quantified through three metrics: completion of the program, the number of participants who enrolled into the program, and the number of participants who commenced the program. Data on adherence were collected automatically through the This Way Up platform. Secondary measures of clinical effectiveness were also collected.Results: Reboot Online combined with telephone support had a positive effect on enrollment and commencement of the program compared with Reboot Online without telephone support. Significantly more participants from the Reboot Online plus telephone support group enrolled (41/44, 93%) into the course than those from the control group (35/45, 78%; χ21=4.2; P=.04). Furthermore, more participants from the intervention group commenced the course than those from the control group (40/44, 91% vs 27/45, 60%, respectively; χ21=11.4; P=.001). Of the participants enrolled in the intervention group, 43% (19/44) completed the course, and of those in the control group, 31% (14/45) completed the course. When considering the subgroup of those who commenced the program, there was no significant difference between the proportions of people who completed all 8 lessons in the intervention (19/40, 48%) and control groups (14/27, 52%; χ21=1.3; P=.24). The treatment efficacy on clinical outcome measures did not differ between the intervention and control groups.Conclusions: Telephone support improves participants' registration, program commencement, and engagement in the early phase of the internet intervention; however, it did not seem to have an impact on overall course completion or efficacy.Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001076167; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619001076167. [ABSTRACT FROM AUTHOR]

Preparing health professionals in New Zealand requires an understanding of the principles of the Treaty of Waitangi (signed in 1840) and of the cultural needs and common illnesses of the Maori people. Inter-professional learning between pharmacy, nursing and medical students was incorporated into the undergraduate curricula at second-year level at the University of Auckland in 2002. Learning about Maori health is achieved through group work, with each mixed-discipline group of 12 students researching one health issue that is prevalent among the Maori, such as diabetes. Maori cultural advisors play a key role in conducting sessions of Te Reo, where they teach simple conversational Maori greetings and traditional songs and introduce cultural concepts. On the final day of the programme, each group presents a poster with their findings and recommendations to fellow students and assessors. Nursing students gave more positive feedback than pharmacy or medical students, and evaluation of the inter-professional programme was overwhelmingly favourable. [ABSTRACT FROM AUTHOR]

Introduction: NetworkZ is a national, insurer-funded multidisciplinary simulation-based team-training programme for all New Zealand surgical teams. NetworkZ is delivered in situ, using full-body commercial simulators integrated with bespoke surgical models. Rolled out nationally over 4 years, the programme builds local capacity through instructor training and provision of simulation resources. We aim to improve surgical patient outcomes by improving teamwork through regular simulation-based multidisciplinary training in all New Zealand hospitals., Methods and Analysis: Our primary hypothesis is that surgical patient outcomes will improve following NetworkZ. Our secondary hypotheses are that teamwork processes will improve, and treatment injury claims will decline. In addition, we will explore factors that influence implementation and sustainability of NetworkZ and identify organisational changes following its introduction. The study uses a stepped-wedge cluster design. The intervention will roll out at yearly intervals to four cohorts of five District Health Boards. Allocation to cohort was purposive for year 1, and subsequently randomised. The primary outcome measure is Days Alive and Out of Hospital at 90 days using patient data from an existing national administrative database. Secondary outcomes measures will include analysis of postoperative complications and treatment injury claims, surveys of teamwork and safety culture, in-theatre observations and stakeholder interviews., Ethics and Dissemination: We believe this is the first surgical team training intervention to be implemented on a national scale, and a unique opportunity to evaluate a nation-wide team-training intervention for healthcare teams. By using a pre-existing large administrative data set, we have the potential to demonstrate a difference to surgical patient outcomes. This will be of interest to those working in the field of healthcare teamwork, quality improvement and patient safety. New Zealand Health and Disability Ethic Committee approval (#16/NTB/143)., Trial Registration Number: Australian and New Zealand Clinical Trials Registry ID ACTRN12617000017325 and the Universal Trial Number is U1111-1189-3992., Competing Interests: Competing interests: AM is Chair of the Health Quality and Safety Commission NZ and a director of SaferSleep LLC. Both AM and CSW hold shares in SaferSleep LLC., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)