'That Terrible Time': Reflections on the 1918 Influenza Pandemic in New Zealand.
Authors: Rice GW PMID: 30161106 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - September 1, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Government climate and health equity priorities must prompt a deeper re-think of health and healthcare for the 21st century.
Authors: Macmillan A, Jones R PMID: 30161107 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - September 1, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Infectious disease and sepsis: not gone, not forgotten.
Authors: Huggan P, Martynoga R PMID: 30161108 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - September 1, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Antimicrobial stewardship practice in New Zealand's rural hospitals.
CONCLUSION: While AMS is perceived as relevant for rural hospital medicine, many of the building blocks of AMS systems are absent in this environment. This presents an opportunity for development as AMS strategies evolve in New Zealand. PMID: 30161109 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - September 1, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Reduction in surgical site infections in the Southern Cross Hospitals network, 2004-2015: successful outcome of a long-term surveillance and quality improvement project.
Authors: Morris AJ, Jackways TM, Morgan A, Robertson R, McIntyre M Abstract AIM: To report on the reduction in the surgical site infection (SSI) rate in the Southern Cross Hospitals network over a 12-year period, 2004-2015, following active surveillance and quality improvement actions. METHODS: Ten hospitals in the network performed prospective SSI surveillance using standard definitions across a range of ten surgical procedure groups. Data was manually collected on a standardised form and entered into a bespoke database. Information collected included timing and dose of surgical antibiotic prophylaxis, type of...
Source: New Zealand Medical Journal - September 1, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Healthcare-seeking behaviour of people with sexually transmitted infection symptoms attending a Sexual Health Clinic in New Zealand.
CONCLUSIONS: This is the first study to quantify healthcare-seeking behaviour for STI in New Zealand. Delayed healthcare-seeking (defined as waiting more than seven days) was common and almost a third of people reported engaging in sex while symptomatic. Enabling prompt healthcare-seeking is crucial to minimise transmission risk. Structural barriers such as the financial cost of STI tests must be removed and education around symptom recognition and healthcare system navigation should be provided. PMID: 30161111 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - September 1, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

100 years since the 1918 influenza pandemic-progress made, yet questions remain. A synopsis of the 4th New Zealand Influenza Symposium, February 2018.
Authors: Charania NA, Turner NM Abstract The year 2018 marks 100 years since the 1918 influenza pandemic that caused devastating social and economic destruction worldwide. Despite substantial progress made with influenza research and strategies to control disease outbreaks, influenza continues to be a global public health problem. This paper presents a synopsis of the 4th New Zealand Influenza Symposium hosted by the Immunisation Advisory Centre in February 2018. During this symposium, international and national experts and service providers convened to discuss strategies to mitigate the effects of seasonal influen...
Source: New Zealand Medical Journal - September 1, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Pro-equity climate change and environmental sustainability action by district health boards in Aotearoa/New Zealand.
CONCLUSION: Current ministerial directives to address both health inequities and DHB greenhouse gas emissions present DHBs with the opportunity to ensure they systematically address both priorities at the same time. In doing so, Aotearoa/New Zealand has the potential to lead the world in demonstrating pro-equity climate change and sustainability action in health systems. PMID: 30161113 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - September 1, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Implementing HIV pre-exposure prophylaxis (PrEP): let's not get caught with our pants down.
Authors: Saxton P, Giola M, Coughlan E, Rich J, Azariah S, Ludlam A, O'Toole C, Pohl M, Myers J Abstract HIV pre-exposure prophylaxis (PrEP) is a daily pill that prevents HIV acquisition. In March 2018, New Zealand became one of the first countries in the world to publicly fund PrEP for individuals at high risk. PrEP promises significantly improved HIV control but is unfamiliar to most health practitioners here, compromising its potential. In this article we review the rationale for PrEP and identify barriers to rapid implementation. The latter include: consumer and health practitioner awareness; acceptability; sca...
Source: New Zealand Medical Journal - September 1, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Blind Pouch Syndrome in Gastrojejunostomy.
Authors: Kommunuri J, Kulasegaran S, Stiven P Abstract Blind pouch syndrome is a rare complication of a gastrojejunostomy. Its presentation may differ from blind pouches at other locations in that a small pouch can cause significant symptoms of mechanical obstruction before it is large enough to develop bacterial overgrowth. The effect of a small pouch may be overlooked at endoscopy and a high clinical index of suspicion is required. Here we present a case report of Gastrojejunostomy Blind Pouch Syndrome to highlight this clinically distinct entity. PMID: 30161115 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - September 1, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Is impetigo a missed opportunity for scabies treatment?
Authors: Thornley S, Sundborn G, Arbuckle M, Loring B, Heather M, Reynolds E PMID: 30161116 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - September 1, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Mitigating the demand for overseas organs through an ethical lens.
Authors: Malpas P PMID: 30161117 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - September 1, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

A genome project for M āori and Pasifika: charting a path to equity in genomic medicine for Aotearoa.
A genome project for Māori and Pasifika: charting a path to equity in genomic medicine for Aotearoa. N Z Med J. 2018 Aug 17;131(1480):8-10 Authors: Kennedy MA PMID: 30116058 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - August 18, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Is there a place for day hospitals in older persons mental health care?
Authors: Croucher M PMID: 30116059 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - August 18, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Provincial or Tertiary Surgical Treatment for Rectal Cancer in New Zealand?
Authors: Bisset I PMID: 30116060 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - August 18, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Psychogeriatric day hospital reduces depression and anxiety symptoms and improves quality of life.
CONCLUSION: Attending a psychogeriatric day hospital that provides time-limited personalised care is associated with statistically significant and clinically meaningful reductions in anxious and depressive symptoms for patients, as well as increasing subjective satisfaction and quality of life. Given the projected rise in the number of older adults in coming decades, the establishment of more psychogeriatric day hospitals should be considered as an alternative to expensive and stretched inpatient services. PMID: 30116061 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - August 18, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

A multicentre, benchmarking study of rectal cancer management in provincial New Zealand hospitals.
CONCLUSION: Management of rectal cancer in provincial hospitals is comparable to specialist centres, however lymph node harvest, reporting of mesorectal grade and complete colonoscopy were factors identified which were lower in the provincial group. Provincial rectal cancer management remains an important resource for patients living outside major centres. PMID: 30116062 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - August 18, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

What keeps Northland general practitioners working in Northland?
CONCLUSIONS: When selecting students or GP registrars to provincial areas or recruiting new GPs to those areas, the values, family connections and lifestyle desires of the candidate and their family should match the environment offered by the region in order to improve retention in that region. PMID: 30116063 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - August 18, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

A media content analysis of New Zealand's district health board Population-Based Funding Formula.
CONCLUSIONS: The findings suggest general discontent with the PBFF model across the DHB sector and a sense that the PBFF has failed to address various challenges facing DHBs. The geographic imbalance in reporting volume suggests that frustration with the PBFF is particularly keenly felt in the South Island. Although the PBFF is a lightning rod for frustrations over limited health funding, the findings point to the need to improve transparency and dialogue around the formula and to monitor of the impact of PBFF allocations throughout the country. PMID: 30116064 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - August 18, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Ethnic disparities in community antibacterial dispensing in New Zealand, 2015.
CONCLUSIONS: The ethnic disparities in the rates of antibacterial dispensing in New Zealand are consistent with, but less marked than, the ethnic disparities in the incidence of infectious diseases in New Zealand. Improved community-wide understanding of both the benefits and the harms of antibacterial medicines is necessary to support improved antibacterial use in New Zealand in the future. PMID: 30116065 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - August 18, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Antipsychotic prescribing in New Zealand between 2008 and 2015.
CONCLUSION: Rates of antipsychotic prescription are increasing. Most of this change is in prescribing atypical antipsychotics. Young Māori males and elderly European females are most likely to receive antipsychotics. PMID: 30116066 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - August 18, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

First, do no harmony: an examination of attitudes to music played in operating theatres.
CONCLUSION: This study, while limited in size, demonstrates that theatre staff generally like music in the operating theatre, and most believe it has a positive impact on several aspects of the theatre environment, though a negative influence on communication. There have been no clinical impact studies on patient and this could be an avenue for future research. PMID: 30116067 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - August 18, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

An audit of regular medication compliance prior to presentation for elective surgery.
CONCLUSIONS: A significant number of patients were non-compliant with their regular medication on the day of surgery. This represents a preventable source of risk that could be addressed by improved patient education or improved organisational pathways. PMID: 30116068 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - August 18, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Genomic medicine must reduce, not compound, health inequities: the case for hauora-enhancing genomic resources for New Zealand.
Authors: Robertson SP, Hindmarsh JH, Berry S, Cameron VA, Cox MP, Dewes O, Doughty RN, Gray G, Jacobsen JC, Laurence A, Matisoo-Smith E, Morton S, Shelling AN, Sika-Paotonu D, Rolleston A, Skinner JR, Snell RG, Sporle A, Print C, Merriman TR, Hudson M, Wilcox P Abstract Precision medicine seeks to draw on data from both individuals and populations across disparate domains to influence and support diagnosis, management and prevention in healthcare at the level of the individual patient and their family/whānau. Central to this initiative is incorporating the effects of the inherent variation that lies within genomes...
Source: New Zealand Medical Journal - August 18, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Redundant laparoscopic adjustable gastric band tubing causing internal hernia and small bowel obstruction.
Authors: Fernandes E, Tan J, Farrant G, Kodeda K PMID: 30116070 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - August 18, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

A new report on the effects of a policy used to restrict access to elective inguinal hernia surgery.
Authors: Bagshaw P PMID: 30116071 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - August 18, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Why is alcohol in the government's 'too hard basket'?
Authors: Sellman D, Connor J PMID: 30048427 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - July 28, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Unprofessional behaviours have no place in the future of medicine.
Authors: Kelly S PMID: 30048428 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - July 28, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Characteristics of lung cancers and accuracy and completeness of registration in the New Zealand Cancer Registry.
CONCLUSIONS: Combining the two sources of data gives a more complete picture of the incidence and tumour characteristics of lung cancer in our region. Our dataset suggests that Māori patients are more likely to have small cell lung cancer than non-Māori patients. PMID: 30048429 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - July 28, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Alcohol consumption in New Zealand women before and during pregnancy: findings from the Growing Up in New Zealand study.
CONCLUSIONS: Drinking is common in New Zealand women before pregnancy, particularly among European and Māori women. Some women consume small amounts of alcohol and some engage in heavy drinking in pregnancy. Both are a risk for fetal harm. Population-wide and targeted measures are needed to reduce consumption overall and provide support to specific population groups. PMID: 30048430 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - July 28, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

How important to dairies is selling tobacco? Views of dairy owners and managers on tobacco retailing.
CONCLUSION: Selling tobacco products is perceived as important for many dairies, and just over half were not interested in becoming a tobacco-free retailer. However, there is some support among dairy owners/managers for tobacco product licensing. These findings strengthen the case for regulatory measures to decrease tobacco availability, as voluntary adoption of tobacco-free retailing is unlikely to result in substantial reductions in outlet numbers. PMID: 30048431 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - July 28, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

The New Zealand Surgical Site Infection Improvement (SSII) Programme: a national quality improvement programme reducing orthopaedic surgical site infections.
Authors: Morris AJ, Roberts SA, Grae N, Hamblin R, Shuker C, Merry AF Abstract AIMS: The New Zealand Surgical Site Infection Improvement (SSII) Programme was established in 2013 to reduce the incidence of surgical site infections (SSI) in publicly funded hip and knee arthroplasties in New Zealand hospitals. METHODS: The programme pursued a three-pronged strategy: 1. Surveillance of SSI with a nationwide system 2. Promotion of consistent adherence to evidence-based practices proven to reduce SSI 3. Monitoring and publicly reporting changed practice and outcome data. RESULTS: Between quarter 3 2013 and quarte...
Source: New Zealand Medical Journal - July 28, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Counting the costs of major trauma in a provincial trauma centre.
Authors: Lee H, Croft R, Monos O, Harmston C Abstract AIMS: Trauma is an important cause of morbidity and mortality in New Zealand, and also represents a significant financial and resource burden on the healthcare system. Understanding local costs and factors that affect them is important for planning of trauma services and obtaining funding for quality improvement projects. The aim of this study was to assess actual costs and influencing factors in patients treated for major trauma in Northland, New Zealand. METHODS: Adult patients admitted to Whangarei Hospital suffering from major trauma for three years from...
Source: New Zealand Medical Journal - July 28, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Improving quality of clinical coding of post-partum haemorrhage: the process and its effects on reported incidence rates in a New Zealand hospital maternity service.
CONCLUSION: This case illustrates the value of coding to a clinical service and the importance of clinical leadership and engagement in achieving successful and sustainable service redesign initiatives. It provides an example of how to evaluate and update coding and a process for changing the way clinicians and coders work that could benefit other services in Waitemata DHB as well as in other New Zealand district health boards. PMID: 30048434 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - July 28, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Media portrayal of M āori and bariatric surgery in Aotearoa/New Zealand.
Media portrayal of Māori and bariatric surgery in Aotearoa/New Zealand. N Z Med J. 2018 Jul 27;131(1479):72-80 Authors: Rahiri JL, Gillon A, Furukawa S, MacCormick AD, Hill AG, Harwood MLN Abstract AIM: Media constructs in Aotearoa, New Zealand naturalise the dominant Western culture. Conversely, mainstream news about Māori is rare and prioritises negative stereotypical constructs that are often centred on Māori as economic threats via resource control and political activism. These narratives influence continued discrimination against Māori in New Zealand. Media representations of bariatric surgery...
Source: New Zealand Medical Journal - July 28, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Time to stop making things worse: an imperative focus for healthcare student bullying research.
Authors: Blakey AG, Anderson L, Smith-Han K, Wilkinson T, Collins E, Berryman E Abstract Student bullying in clinical practice remains a concern, and evidence regarding what works to specifically help the student appears rather piecemeal. At the same time, emergent literature indicates that some bullying interventions can be ineffective for behaviour change, or even deleterious to the staff which they target. Considering the potentially sizeable financial and personal costs associated with continued bullying and undertaking an intervention, it would seem sensible that any selected intervention method avoids those s...
Source: New Zealand Medical Journal - July 28, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Topiramate induced renal tubular acidosis.
Authors: Florkowski CM, Soule SG PMID: 30048437 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - July 28, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Enough doctors support the End of Life Choice Bill to make it operable.
Authors: Havill J, Williams M, Kuten J, Kueppers F, Macdonald A, Payinda G, Koshy S, Glover A, Baskett J, Davidson J, Sparrow M, Stephens R, Smales L, Johnson L, Shand C, Musgrove J PMID: 30048438 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - July 28, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

A response to Primum non nocere: first do no harm.
Authors: Bunkle P PMID: 30048439 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - July 28, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

A response to: Characteristics of lung cancers and accuracy and completeness of registration in the New Zealand Cancer Registry.
Authors: James V, Fowler C PMID: 30048440 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - July 28, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Transplant ethical considerations: response from the trenches.
Authors: Munn S PMID: 30001300 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - July 13, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

The Zero Carbon Bill and the health of New Zealanders-help shape this crucial health law now.
Authors: Forde A, Springford L, Metcalfe S PMID: 30001301 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - July 13, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Comparing methamphetamine, MDMA, cocaine, codeine and methadone use between the Auckland region and four Australian states using wastewater-based epidemiology (WBE).
CONCLUSIONS: MDMA and cocaine use is low in Auckland compared to sampled Australia cities. Both Auckland and the selected Australian cities have significant methamphetamine problems compared to many European cities. PMID: 30001302 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - July 13, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Trends in ischaemic heart disease: patterns of hospitalisation and mortality rates differ by ethnicity (ANZACS-QI 21).
CONCLUSION: Fatal and non-fatal IHD rates are declining in all groups, but Māori and Pacific people have disproportionately high rates of IHD mortality. The much lower ratio of IHD hospitalisations to deaths among Māori and Pacific people compared to others suggests there are still important barriers to preventive interventions and acute care for Māori and Pacific men and women. PMID: 30001303 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - July 13, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Chromoendoscopy versus standard colonoscopy for detection of nonpolypoid dysplasia in patients with inflammatory bowel disease.
CONCLUSION: In our cohort of IBD patients undergoing surveillance colonoscopy, CE with targeted biopsy is associated with a significantly increased nonpolypoid dysplasia detection rate when compared to WLE. These results are comparable to studies performed in the rest of the world. PMID: 30001304 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - July 13, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Institutional gastroenteritis outbreaks and time to notify public health services.
CONCLUSION: Prompt notification to the PHS appears to be a factor associated with reduced outbreak duration and size. PMID: 30001305 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - July 13, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Pregabalin misuse: preventing potential problems in New Zealand.
CONCLUSIONS: Prescribers need to be alert to the potential of pregabalin misuse. This should be achieved through prescribing with great care (not prescribing to new or unknown patients; not in response to direct patient requests for it by name; supplying in limited quantities), regular review of patients and stopping treatment, by slow withdrawal, when lack of efficacy is seen. PMID: 30001306 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - July 13, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

New Zealand transplant patients and organ transplantation in China: some ethical considerations.
Authors: Malpas P Abstract In this viewpoint article we consider the situation of organ procurement from China, and address some of the ethical aspects arising for health professionals when New Zealand transplant patients contemplate traveling to China for an organ. We also consider some of the challenges facing health professionals involved in providing care to such patients. PMID: 30001307 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - July 13, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Traumatic haemorrhagic lumbar synovial facet cyst presenting as bilateral foot drop: a case report.
Authors: Bodian C, Davis J, Hadlow A PMID: 30001308 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - July 13, 2018 Category: General Medicine Tags: N Z Med J Source Type: research

Applying the Reason Model to enhance health record research in the age of 'big data'.
Authors: Ragupathy R, Yogarajan V PMID: 30001309 [PubMed - in process] (Source: New Zealand Medical Journal)
Source: New Zealand Medical Journal - July 13, 2018 Category: General Medicine Tags: N Z Med J Source Type: research