Doctors' views on the impact of the absence of an in-person rheumatology service at a major New Zealand hospital.

AIM: To describe the views of doctors in one hospital service about the impact of the lack of an in-person rheumatology consultation service and to identify service improvements informed by those views and services at comparable district health boards (DHB). METHODS: Qualitative study using focus groups of resident and senior medical officers (RMOs and SMOs) from the general medical service at Wellington Regional Hospital. A national survey of DHB heads of rheumatology was also used. RESULTS: Three major categories emerged from the focus groups with 16 RMOs and 15 SMOs: 1) a negative impact on quality of patient care, which is inequitable to other nearby DHBs; 2) workarounds are found; and 3) doctors' knowledge of rheumatology and education opportunities suffer. Best practice was considered to be an in-person rheumatology consultation service, as offered at the six DHBs surveyed. CONCLUSIONS: Lack of an in-person rheumatology consultation service in this large hospital had perceived negative impacts on patient care and doctors' education and competence. Providing an in-person consultation service seems highly desirable but would need more rheumatology capacity regionally. The themes identified may also be relevant to other hospital or specialist services that are not equitably accessible in other parts of the New Zealand health system and thus inform the transformation of the health system required by the Pae Ora (Healthy Futures) Bill 2022.

The clinical utility of Memorial Symptom Assessment-Short Form and Condensed Memorial Symptom Assessment Scale in Turkish lung cancer patients.

INTRODUCTION: Symptom assessment is essential in the palliative care of patients with cancer. We studied the Memorial Assessment Scale Test-Short Form (MSAS-SF) and Condensed Memorial Assessment Test (CMSAS) in Turkish lung cancer patients. MATERIAL AND METHOD: Fifty-one patients with lung cancer (47 non-small, 4 small cell) were staged according to the International Association for the Study of Lung Cancer 2007 and filled the MSAS-SF. Karnofsky performance status, TNM staging, MSAS-SF and CMSAS scores were recorded. The study was approved by the local research ethics committee. RESULTS: The mean age of 51 patients was 61.7 ± 9. Fifty-one percent were staged as M1 while 49% were staged as M0. The mean values for global distress index, PHYS (physical symptom distress), PSYCH (psychological symptom score) and MSAS-SUM were 1.15 ± 0.8, 0.9 ± 0.8, 1.13 ± 1.03 and 0.82 ± 0.47 in order. The mean values for CPHYS (physical symptom distress for Condensed MSAS), CPSYCH (psychological symptom score for CMSAS) and CSUM (sum scores) were 1.2 ± 0.75, 1.22 ± 1.1 and 1.16 ± 0.69 in order. Cronbach's alpha coefficients for MSAS-SF and CMSAS were 0.861 and 0.728 in order. Summary scores for both MSAS-SF and CMSAS-SF were significantly higher in patients with M1 disease than from M0 disease. In addition, PHYS and MSAS-SUM in MSAS-SF were significantly correlated with T and N stage. The area under curve for MSAS-SF and CMSAS were 0.793 and 0.70 in order. CONCLUSION: MSAS-SF and CMSAS demonstrated significantly higher scores in lung cancer patients with M1 disease than patients with M0 disease. Further studies are needed to evaluate the usefulness of MSAS-SF and CMSAS in lung cancer patients.

Pleural complications of pulmonary hydatid disease.

OBJECTIVE: The aim of this study was to determine the incidence and diagnostic features of pleural manifestations of pulmonary hydatid disease. METHODOLOGY: Patients with pleural pathology in association with surgery for pulmonary hydatid disease over an 8-year period were evaluated. RESULTS: Twenty-nine (6%) of 474 patients with histologically confirmed pulmonary hydatid disease had pleural abnormalities. The diagnosis was determined preoperatively in 22 patients and was based on radiographic, clinical, and/or serology findings. Bronchoscopic specimens were diagnostic in two of seven patients who had bronchoscopy. Five patients were not diagnosed until surgery. Radiographic abnormalities consisted of pleural thickening and/or free fluid without intrapleural rupture of the cysts in 21 patients. Eight patients had a hydropneumothorax. Sixteen patients had an exudative, uncomplicated effusion. The remaining patients had empyemas. All patients had resection of the pulmonary cysts, and 20 also underwent a pleurectomy. The mean length of hospital stay was 23 +/- 14 days. There was no hospital mortality. CONCLUSION: Pleural lesions associated with pulmonary hydatid disease are rare and have a variable radiographic appearance. In regions in which echinococcal disease is endemic, a high level of clinical suspicion is necessary for diagnosis and appropriate management of this condition.