WAIKATO CLINICAL SCHOOL

FACULTY OF MEDICAL AND HEALTH SCIENCES UNIVERSITY OF AUCKLAND

ANNUAL REPORT 2012

Waikato Clinical School Annual Report 2012 Assistant Dean Professor Ross Lawrenson Deputy Head of School Associate Professor Peter Jones School Manager Mrs Raewyn Wooderson Research Coordinator Associate Professor John Conaglen Head of Postgraduate Studies Dr Jacquie Kidd Head of Undergraduate Teaching Dr Wayne de Beer Academic Coordinator, Rotorua Dr Nic Crook Names of Management Committee Members (for University Centres and Institutes) As above plus Professor Graham Mellsop Professor Jamie Sleigh The Waikato Clinical School is an academic division of The University of Auckland, Faculty of Medical and Health Sciences. The School provides clinical teaching for undergraduate medical students and is involved in postgraduate training and research. The School supports the School of Nursing’s post-graduate programme and a number of university-led projects that are based in Waikato. The main purpose of the School is to provide an outstanding environment in which medical students can undergo their clinical training. We aim to pursue excellence in teaching and learning through exposure of our students to high quality clinical teachers. The School is also committed to developing and increasing its research performance and the number and quality of its postgraduate students in line with The University of Auckland’s strategy.

WCS Annual Report 2012 Page 3 of 24

Our Mission Statement The Waikato Clinical School first and foremost aims to provide an excellent clinical learning environment for students. The School also aims to increase both its clinical and basic research and encourage increasing liaison with researchers in New Zealand and internationally. Affiliations and Collaborations The Waikato Clinical School could not operate without the support and input from a number of key collaborators. In particular we recognise the considerable support we receive from the Waikato District Health Board. We also have strong links with Lakes and the Bay of Plenty DHBs and Midlands Health Network. Over the years the School has received funding from the Waikato Medical Research Foundation and appreciate its ongoing support of research. Our History An agreement concerning the formation of the Waikato Academic Division, (renamed the Waikato Clinical School in 2001) was signed by Prof Peter Gluckman from the University of Auckland and Dr Tony Cull, Health Waikato CEO in 1994 and in November 1994 the first cohort of 24 final year medical students commenced. The school grew rapidly under the leadership of Dr Peter Rothwell and became a clinical teaching centre with an excellent reputation for providing clinical experience and a supportive environment for the students. In 2002 a new building incorporating the Clinical Skills Centre and the Library was opened and named the ‘Peter Rothwell Academic Centre’. Dr Rothwell was succeeded by Dr Jack Havill in 2003 and Prof Ross Lawrenson in 2005. The Chief Executive Officer of the Waikato DHB from 1998 to 2005 was Dr Jan White who not only supported the Waikato Clinical School as a teaching centre but also supported research with the establishment of Chairs in Medicine, Anaesthetics, Psychiatry and Primary Health Care. This support for research has been continued by the current administration led by the CEO, Mr Craig Climo. The University of Auckland greatly values their strategic partnership with the Waikato DHB and formally signed a ‘Strategic Alliance Agreement’ in November 2005. The Rotorua campus was started in 2003 with the placement of 12 Trainee Interns (6th year medical students) at Rotorua Hospital. In 2009 the Faculty of Medical and Health Sciences signed an agreement with the Bay of Plenty District Health Board. Waikato Clinical School 5th year students have the opportunity to spend some of their clinical time at both Lakes and Bay of Plenty DHB.

WCS Annual Report 2012 Page 4 of 24

Undergraduate Students The purpose of the school is to provide an outstanding environment in which medical students can undergo their clinical training and to pursue excellence in teaching and learning through exposure to high quality clinical teachers. Medical students from The University of Auckland apply to undertake clinical training at the Waikato Clinical School and can be accommodated in most specialties in the 4th, 5th and 6th years of the course. “Selective” attachments are also available and there are a limited number of overseas elective students accepted each year. Trainee Intern positions are available at both the Waikato and the Rotorua Campuses. In 2012 we had a “Midland 5th Year Cohort” consisting of 40 students who have had clinical attachments in Waikato, Rotorua and Tauranga Hospitals. We also had 30 Trainee Interns at Waikato and 11 at Rotorua. Of these, 12 Waikato DHB students have taken up PGY1 positions at Waikato Hospital and 2 students at Rotorua. This is the 2nd year that Waikato Clinical School have taken a full cohort of 5th year medical students. Hauora Māori The School continues its partnership with Te Puna Oranga (Māori Health Unit). The HRC-funded project Oranga Tane Māori – Maori Men’s Health finished in October 2012. This project reviewed the impact of a whanau ora approach to Maori men’s health. The principal investigator was Mrs Erena Kara (previously Mr Wayne Johnstone) and Prof. Ross Lawrenson, Dr Veronique Gibbons and Dr Jacquie Kidd from the Waikato Clinical School were co-investigators. A number of publications have been published, accepted or are in the pipeline from this project. Professor Ross Lawrenson participated in a Health Literacy Study with Rauawaawa Kaumātua Services, which looked at Māori Health Literacy and Palliative Care. Professor Ross Lawrenson and Dr Veronique Gibbons contributed to a study investigating emergency department presentation for patients with palliative care needs and identifying whether there were differences in Māori and non-Māori presentation. In late 2012, Dr Jacquie Kidd led the sister project which examined Māori health literacy in palliative care in the Bay of Plenty and Auckland regions. Professor Graham Mellsop continues to work with Dr Kahu McClintock on Hua Oranga (Māori Mental Health Outcome Measurement) and the development of other measures relevant to the provision of mental health services to Maori, in collaboration with Te Rau Matatini.

Professor Lawrenson is principal investigator on a study of the costs and complications of prostate cancer funded by the HRC. Part of this study has been looking at the cause of the inequity in outcomes for Māori patients with prostate cancer. Dr Nina Scott from Te Puna Oranga has been the Māori advisor and co-investigator of this project. We have also had the support of Mr Rawiri Blundell with Midland Cancer Network Maori Advisory Group.

WCS Annual Report 2012 Page 5 of 24

Associate Professor Ian Campbell and Professor Lawrenson are supervising a PhD student Dr Sanjeewa Seneviratne who is looking at the cause of differential outcomes for Māori woman with breast cancer. Dr Rawiri Keenan is Medical Advisor with Midlands Health Network. Dr Keenan is undertaking postgraduate studies in General Practice and is involved in joint research between Midlands Health Network and the Waikato Clinical School. Elective Students The WCS hosted 29 elective students in 2012. The WCS declined 142 elective students. Many of our elective applications are from the UK and Germany. WCS Prizes 2012 The David Clews Prize for Best Student at Waikato Clinical School For the student that best reflects the attributes of academic excellence, leadership and contribution to the community: Samuel Whittaker Waikato TI Prize in General Practice sponsored by Midlands Health Network For the trainee intern that achieves the highest summation of individual marks awarded for performance during the general practice attachments: Thomas Reynolds Ellis Dick Trainee Intern Prize for Surgery For the most outstanding trainee intern in surgery: Matthew Jeans Peter Rothwell Clinical Teacher Award For recipients that show excellence in clinical training: Dr Deirdre Rohlandt Rotorua Teachers Award Dr Stephen Bradley Rotorua Trainee Intern Prize Qi Hong Wong

Trainee Intern Prize for Excellence in Psychiatry Qi Hong Wong Postgraduate Study There were 7 PhD scholars, 6 MD students and 2 masters students registered

WCS Annual Report 2012 Page 6 of 24

with The University of Auckland with supervisors from Waikato Clinical School during 2012. Current PhD Students Dr Nathaniel Chiang (supervised Prof Jamie Sleigh) Chunhuan Lau (supervised by Prof Ross Lawrenson) Zuzana Obertova (supervised by Prof Ross Lawrenson) Dr Sanjeewa Seneviratne (supervised by Prof Ross Lawrenson) Dr Ryan Paul (supervised by Assoc Prof John Conaglen) Dr Jade Tamatea (supervised by Assoc Prof John Conaglen) Alice Wang (supervised by Prof Lynn Ferguson) MD In 2012 there were 6 Waikato doctors enrolled for an MD with The University of Auckland Dr Sangeeta Dey (supervised by Prof Graham Mellsop) Dr Corrine Law (supervised by Prof Jamie Sleigh) Dr Sarina Lim (supervised by Assoc Prof John Conaglen) Dr Jane Morgan (supervised by Prof Ross Lawrenson) Dr Paul Timmings (supervised by Prof Jamie Sleigh) Dr Gerry Devlin (supervised by Assoc Prof John Conaglen) Masters Poornima Nair (supervised by Prof Ross Lawrenson) Rawiri Keenan (supervised by Prof Ross Lawrenson) Research There are four professorial units within the Waikato Clinical School: Medicine, Anaesthetics, Psychiatry and Primary Care. The establishment of these units was initially funded by the Waikato District Health Board. All of our researchers work closely with their respective departments in the Faculty of Medical and Health Sciences in Auckland. Medicine The research interests of the Department of Medicine at the Waikato Clinical School include Cardiology, Oncology, Endocrinology, Dermatology and Rheumatology. Key academic staff involved with research include: Associate Professor John Conaglen (Endocrinology and Sexual Dysfunction) Dr Marianne Elston (Endocrinology), and Dr Win Meyer-Rochow (Endocrine Surgery); Associate Professor Peter Jones (Rheumatology); Dr Gerry Devlin, Dr Martin Stiles, & Dr Mark Davis (Cardiology); Associate Professor Amanda Oakley and Associate Professor Marius Rademaker (Dermatology); Dr Nic Crook (Diabetes, Endocrinology - Rotorua); and Dr Michael Jameson (Oncology). The department

WCS Annual Report 2012 Page 7 of 24

has strong links with AgResearch at Ruakura and has published a number of papers in collaboration with their researchers. Cardiology Gerry Devlin is a Cardiologist and Senior Lecturer in Medicine with the Waikato Clinical School, University of Auckland. He is current Clinical Unit Leader of cardiac services at Waikato Hospital and Clinical Leader of the Midland Cardiac Network. He recently was awarded a Doctor of Medicine from the University of Auckland (supervised by A/P John Conaglen). In his thesis Gerry investigated the insulin-like growth factors in the failing heart. Martin Stiles is a Cardiologist and Senior Lecturer specialising in electrophysiology. His PhD was on the ‘Characterisation of the Substrate of Atrial Fibrillation and Flutter’ at the University of Adelaide. He returned to Waikato Hospital in 2008. In 2012, Martin was the recipients of the Waikato Clinical School Medical Science Award at the annual Kudos Awards, the Hamilton Science Excellence Awards. Publications Mazhar J, Killion B, Liang M, Lee M, Devlin G. Chest Pain Unit (CPU) in the Management of Low to Intermediate Risk Acute Coronary Syndrome: A Tertiary Hospital Experience from New Zealand. Heart Lung Circ. 2012. Liang M, Liew TV, Puri A, Hyde L, Devlin G. Medium to long-term clinical outcomes with everolimus-eluting stents in real-life percutaneous coronary intervention. Annals of the Academy of Medicine, Singapore. 2012;41(6):252-7. Sangu PV, Ranasinghe I, Aliprandi Costa B, Devlin G, Elliot J, Lefkovitz J, et al. Trends and predictors of rehospitalisation following an acute coronary syndrome: report from the Australian and New Zealand population of the Global Registry of Acute Coronary Events (GRACE). Heart. 2012 23:1728-31.

New Zealand 2012 guidelines for the management of non ST-elevation acute coronary syndromes N Z Med J. 2012;125(1357):122-47

Swampillai J, Liang M, Fisher R, Devlin G. Enterococcus gallinarum causing native valve endocarditis and aorto-atrial fistula: a case report and literature review. Echocardiography. 2012 7:873-5. Liang M, Mansell C, Wade C, Fisher R, Devlin G. Unusually virulent coagulase-negative Staphylococcus lugdunensis is frequently associated with infective endocarditis: a Waikato series of patients. N Z Med J. 2012;125(1354):51-9. Liang M, Devlin G, Pasupati S. The incidence of transcatheter aortic valve implantation-related heart block in self-expandable Medtronic CoreValve and

WCS Annual Report 2012 Page 8 of 24

balloon-expandable Edwards valves. The Journal of invasive cardiology. 2012;24(4):173-6. Swampalli J, Wijesinghe N, Sebastian C, Devlin G. Seasonal variations in hospital admissions for ST-elevation myocardial infarction in New Zealand. Cardiol Res. 2012;3(5):205-8. Namboodiri N, Stiles MK, Young GD, Sanders P. Electrophysiological features of atrial flutter in cardiac sarcoidosis: a report of two cases. Indian pacing and electrophysiology journal. 2012;12(6):284-9. Webber MR, Stiles MK. Recommendations for the programming of implantable cardioverter-defibrillators in New Zealand. Heart Lung Circ. 2012;21(12):765-77. Ogawa S, Aonuma K, Huang D, Huang J, Kalman J, Kamakura S, et al. Fact-finding survey of antithrombotic treatment for prevention of cerebral and systemic thromboembolism in patients with non-valvular atrial fibrillation in 9 countries of the Asia-Pacific region. J Arrhythmia. 2012;28:41-5. Wilson D, Harding SA, Melton I, Lever NA, Stiles MK, Boddington D, et al. Geographic, ethnic and socioeconomic factors influencing access to implantable cardioverter defibrillators (ICDs) in New Zealand. Heart Lung Circ. 2012;21(9):576-81. Sy RW, Thiagalingam A, Stiles MK. Modern electrophysiology mapping techniques. Heart Lung Circ. 2012;21(6-7):364-75. Dimitri H, Ng M, Brooks AG, Kuklik P, Stiles MK, Lau DH, et al. Atrial remodeling in obstructive sleep apnea: implications for atrial fibrillation. Heart rhythm : the official journal of the Heart Rhythm Society. 2012;9(3):321-7. Endocrinology Associate Professor J V Conaglen heads the Department of Endocrinology at the Waikato Hospital and has active research links with Dr Marianne Elston, Endocrinologist and Dr Goswin Meyer-Rochow, Endocrine Surgeon. Together they have formed the Waikato Endocrine Research Unit. Dr Marianne Elston was a finalist in the recently announced New Zealand Prime Minister’s Science Prizes. In collaboration with Drs Gerard Devlin, Chris McMahon and Sarina Lim, the Cardioendocrine Research Group has extended their repertoire of animal models by developing a murine model to further understand the role of myostatin in preventing loss of cardiomyocytes after myocardial infarction. Drs Conaglen, Elston and McMahon are supervising PhD student Dr Ryan Paul who is investigating the effects of growth hormone replacement on myostatin in growth hormone deficient patients. Dr Meyer-Rochow has an active research interest in

WCS Annual Report 2012 Page 9 of 24

clinical and molecular aspects of phaeochromocytomas and paraganglioma. In addition to ongoing phaeochromocytoma research studies, the endocrine group are also actively researching thyroid disease. A presentation based on the thyroid work by Dr Jade Tamatea, the senior Endocrine Registrar, won the best presentation award at the Australasian Endocrine Conference this year. Publications Elston MS, Meyer-Rochow GY, Holdaway I, Conaglen JV. Patients With RET D631Y Mutations initially present with phaeochromocytoma, not medullary thyroid carcinoma. Hormone and Metabolic Research. 2012;44:339-42. Paul R, Elston MS, Gill AJ, Marsh D, Beer I, Wolmarans L, et al. Hypercalcaemia due to parathyroid carcinoma presenting in the third trimester of pregnancy. ANZ Journal of Obstetrics and Gynaecology. 2012;52:204-7. Tamatea JAU, Tu’akoi K, Conaglen JV, Elston MS, Meyer-Rochow GY. Thyroid Cancer in Graves’ disease: Is surgery the best treatment for Graves’ disease? . ANZ Journal of Surgery. 2012. Sexual Health Research Unit Associate Professor J V Conaglen is a leading researcher into sexual health and continues to conduct studies into the dyadic effects of sexual dysfunction. Along with Dr Helen Conaglen, The Sexual Health Research Unit facilitates education and research in the field of sexual dysfunction in New Zealand by promoting an increased understanding and awareness of sexual function and dysfunction for health and allied professionals and the general public. The Unit is a multidisciplinary team with expertise in medicine, endocrinology, clinical psychology, sexual health, and research methodology, and links with public health and education. The SHRU team is working on sexual function following treatment for prostate cancer as part of the Midlands Prostate Cancer Study. They have this year completed a pilot study investigating the impact on Couples of a Man’s Localised Prostate or Colon Carcinoma Treatment, and published an investigation of the impact of brachytherapy on sexual function. In addition, Dr Helen Conaglen has supervised Ms Angela Rennie, who completed a Masters study of women suffering with vulvodynia investigating the impact of the treatment options available to them. Publications O’Connor EJ, Conaglen HM, J.V. C, McCabe MP. Attitudes and experiences: Qualitative perspectives on erectile dysfunction from the female partner. Health Psychology. 2012;;17:3-13.

WCS Annual Report 2012 Page 10 of 24

Conaglen HM, Conaglen JV. Couple’s reasons for adherence to, or discontinuation of, PDE-type 5 inhibitors for men with erectile dysfunction at 12-24 month follow-up after a 6-month free trial. Sexual Medicine. 2012;9:857-65.

Conaglen HM, Conaglen JV. Why stop a good thing? Discontinuing PDE5 inhibitors. Nature Reviews Urology. 2012;9:483-5.

Conaglen HM, de Jong D, Hartopeanu C, Conaglen JV, Tyrie LK. The Effect of High Dose Rate Brachytherapy in Combination with External Beam Radiotherapy on Men's Health-related Quality of Life and Sexual Function over a 2 Year Time Span. Clinical Oncology. 2012. Rheumatology Associate Professor Peter Jones is an academic researcher and Rheumatologist with the Waikato Hospital Rheumatology Unit. ‘The Genetics of Gout in Aotearoa’ project (HRC Programme grant) continues recruitment from the rheumatology clinics, and is producing some interesting results. A focus this year has been on the metabolic syndrome and gout, and the relationship between consumption of sugar-sweetened beverages and hyperuricaemia. Evidence for an interaction between genes and environmental factors has been found. The Unit has been active in clinical research, enrolling patients in studies of a new uricosuric agent for gout, and in studies of new biologic drugs for rheumatoid arthritis and psoriatic arthritis. Publications Chen-Xu M, Topless R, McKinney C, Merriman ME, Phipps-Green A, Dalbeth N, et al. Replication of association of the interleukin 23 receptor rs1343151 variant with rheumatoid arthritis in Caucasian sample sets. Annals of the rheumatic diseases. 2012;71(1):155-7. Dalbeth N, Pui K, Lobo M, Doyle A, Jones PB, Taylor WJ, et al. Nail disease in psoriatic arthritis: distal phalangeal bone edema detected by magnetic resonance imaging predicts development of onycholysis and hyperkeratosis. The Journal of rheumatology. 2012;39(4):841-3. Hsu A, Dalbeth N, Gow P, Harrison A, Highton J, Jones PB, et al. No evidence for association of Chr 9p21 variatn rs1333049 with gout in New Zealand case-control sample sets (letter). Rheumatology. 2012. Hollis-Moffatt JE, Phipps-Green AJ, Chapman B, Jones GT, van Rij A, Gow PJ, et al. The renal urate transporter SLC17A1 locus: confirmation of association with gout. Arthritis research & therapy. 2012;14(2):R92. Stamp LK, Taylor WJ, Jones PB, Dockerty JL, Drake J, Frampton C, et al. Starting dose is a risk factor for allopurinol hypersensitivity syndrome: a proposed safe

WCS Annual Report 2012 Page 11 of 24

starting dose of allopurinol. Arthritis and rheumatism. 2012 Hollis-Moffatt JE, Phipps-Green AJ, Chapman B, Jones GT, van Rij A, Gow PJ, et al. The renal urate transporter SLC17A1 locus: confirmation of association with gout. Arthritis research & therapy. 2012;14(2):R92. Respiratory Respiratory Medicine continues to run an active research unit. Dr Noel Karalus is one of the lead investigators in two HRC-funded studies in bronchiectasis and tuberculosis in conjunction with the School of Medicine and the University of Waikato, whilst Associate Professor Bob Hancox (University of Otago) continues to provide invaluable support and guidance to overall research planning and analysis. In addition, Dr Cat Chang returned to the Department after finishing her training in Sydney and being awarded a MD in July, 2011, and continues with her research interests. The Waikato Respiratory Research Unit has current active research projects looking into the treatment of bronchiectasis, cystic fibrosis, obstructive airways disease and community acquired pneumonia with recent publications in each of these subjects. The Unit continues to fund and supervise a doctoral research fellow. Oncology Dr Michael Jameson, Honorary Senior Clinical Lecturer, and Dr Marion Kuper work within The Regional Cancer Centre at Waikato Hospital, which spans medical and radiation oncology, haematology and palliative care, with staff actively involved with service development both at a local and national level. A key focus for the service, in addition to quality of patient care, is research and staff education/development. Publications Kuper-Hommel MJ, Janssen-Heijnen ML, Vreugdenhil G, Krol AD, Kluin-Nelemans HC, Coebergh JW, et al. Clinical and pathological features of testicular diffuse large B-cell lymphoma: a heterogeneous disease. Leukemia & lymphoma. 2012;53(2):242-6. Kuper-Hommel MJJ, van Krieken JHJM. Molecular pathogenesis and histologic and clinical features of extranodal marginal zone lymphomas of mucosa-associated lymphoid tissue type. Leukemia & lymphoma. 2012;53(6):1032-45. Dermatology The Department of Dermatology at Waikato Hospital provides a leading role within New Zealand for both teaching and research. The Department has a strong academic focus, and is particularly noted for its research and publications on medical dermatology, teledermatology and teledermoscopy. Staff includes Hon. Associate Professor Marius Rademaker and Hon Associate Professor

WCS Annual Report 2012 Page 12 of 24

Amanda Oakley. The department has a special interest in applying technology to dermatological education and teleconsultation. Senior medical staff members have presented at numerous international meetings and have published original research papers, case reports, reviews and critical appraisals for peer reviewed and general medical journals and textbooks. Amanda Oakley, with assistance from her colleagues in the department, has developed a comprehensive worldwide web site for the New Zealand Dermatological Society, NZ DermNet (www.dermnetnz.org). The site includes comprehensive information for patients about more than 1000 conditions and treatments and Continuing Medical Education for health professionals.

Professor Oakley and Dr Rademaker have been made International Honorary Members of the American Dermatological Association (Oakley) and Mexican Academy of Dermatology (Rademaker). Dr Oakley was further awarded an Honorary Membership of the American Academy of Dermatology, and Dr Rademaker a member of Sigma Si, the Scientific Research Society.

Professor Amanda Oakley - photograph supplied by Waikato District Health Board

Publications Lim D, Oakley AM, Rademaker M. Better, sooner, more convenient: a successful teledermoscopy service. The Australasian journal of dermatology. 2012;53(1):22-5. Lim D, Goodman H, Rademaker M, Lamont D, Yung A. Blastic plasmacytoid dendritic cell neoplasm. The Australasian journal of dermatology. 2012 Rademaker M, Derraik J. Phytodermatitis caused by Ficus pumila. Dermatitis. 2012; 67:53-6. Simpkin S, Oakley A. Multiple eruptive squamous cell carcinoma in a patient with

WCS Annual Report 2012 Page 13 of 24

chronic plaque psoriasis on adalimumab. The Australasian journal of dermatology. 2013;54(1):55-8. Rademaker M. Isotretinoin: dose, duration and relapse. What does 30 years of usage tell us? The Australasian journal of dermatology. 2012. Rademaker M. Face-masks for facial atopic eczema: Consider a hydrocolloid dressing. The Australasian journal of dermatology. 2012..

Surgery

The Department of Surgery have a number of academic appointments including A/P Ian Campbell, Mr Win Meyer-Rowhow and Mr Thodor Vaseudavan. In addition Mr Askar Kukkady and Mrs Udaya Samarakkody lead an active paediatric surgical department.

Mr Adam el Gamel is the Clinical Director of the Cardiothoracic Surgical Unit. Research themes include breast surgery, endocrine surgery (see Department of Medicine) vascular/cardiothoracic surgery and paediatric surgery. Breast Surgery Associate Prof Ian Campbell continues to publish and present data from the Waikato Breast Cancer Register and National Breast Cancer Audit. Dr Sanjeewa Seneviratne, a PhD scholar from Sri Lanka, is presently undertaking a research project to investigate reasons for poor outcomes among Maori women with breast cancer in the Waikato region supervised by Assoc Prof Ian Campbell and Prof. Ross Lawrenson. This three year project is expected to analyse data from approximately 5000 women with breast cancer diagnosed in the Waikato over a period of 20 years. Publications Ooi CW, Campbell ID, Kollias J, de Silva P. National Breast Cancer Audit: overview of invasive breast cancer in New Zealand. N Z Med J. 2012;125(1359):7-16. Seneviratne SA, Lawrenson R, Hamilton M-A, Munt C, Coles C, Scott N, et al. Could delays in treatment be a factor in poorer outcome for Maori women with Breast cancer? Biannual Research Seminar. 2012;125 (1364). Roder DM, de Silva P, Zorbas HN, Webster F, Kollias J, Pyke CM, et al. Adherence to recommended treatments for early invasive breast cancer: decisions of women attending surgeons in the breast cancer audit of Australia and New Zealand. Asian Pacific journal of cancer prevention : APJCP. 2012;13(4):1675-82. Roder D, de Silva P, Zorbas H, Kollias J, Malycha P, Pyke C, et al. Survival from synchronous bilateral breast cancer: the experience of surgeons participating in the breast audit of the Society of Breast Surgeons of Australia and New Zealand.

WCS Annual Report 2012 Page 14 of 24

Asian Pacific journal of cancer prevention : APJCP. 2012;13(4):1413-8. Asim M, Cham A, Banerjee S, Nancekivell R, Dutu G, McBride C, et al. Difficulties with defining lymphoedema after axillary dissection for breast cancer. N Z Med J. 2012;125(1351):29-39. Roder DM, de Silva P, Zorbas HM, Kollias J, Malycha PL, Pyke CM, et al. Age effects on survival from early breast cancer in clinical settings in Australia. ANZ J Surg. 2012;82(7-8):524-8. Paediatric Surgery Health Waikato have a very active Department of Paediatric Surgery which runs a tertiary regional service for the Midland region with an extensive outreach service. The department has a special interest in Neonatal Surgery, Paediatric Urology and Minimal Access Surgery. They also have a particular interest in congenital abdominal wall defects and chest wall anomalies. The department accepts regular students from the University of Auckland; additionally it is open to selective and elective students from New Zealand and overseas. There is an extensive teaching program and a research program available to such students. Cardiothoracic Surgery Mr Adam el Gamel is leading research in the area of cardiothoracic surgery in conjunction with Vascular Surgeon Mr Thodur Vasudevan. Publications Galvin SD, Sinha SK, El-Gamel A. Cavernous hemangioma of the right atrium. Journal of cardiac surgery. 2012;27(3):360. Epub 2012/02/03.

Paediatrics Paediatric Medicine at Waikato forms part of a spectrum of services under the Waikids umbrella which includes Mothercraft, Child Development Centre, Children's Clinic, Mental Health services, Emergency Department, Child Protection Service, Oral Health, and inpatients. Dr David Graham has been the principal investigator in a randomised intervention study of exercise in school children funded by the Waikato DHB - Project Energize. The intervention arm is being run by Sport Waikato. Dr Anne Jaquiery is based in Rotorua and has a joint appointment with the Liggins Institute and the Waikato Clinical School. Her area of interest is foetal nutrition and its effects on subsequent development. Mrs Deborah Harris finalised her PhD with the Liggins Institute co-supervised by Dr Phil Weston. David Graham has been an Honorary Clinical Senior Lecturer in the Department of Paediatrics: Child and Youth Health for 20 years. He became the first 2012 Dennis Pickup Award recipient from the School of Medicine. He has led the

WCS Annual Report 2012 Page 15 of 24

undergraduate teaching programme for paediatric trainee interns at the Waikato District Health Board and contributes actively to Paediatric 5th year teaching and postgraduate teaching. Publications Shingler S, Hunter K, Romano A, Graham D. Opportunities taken: the need for and effectiveness of secondary care opportunistic immunisation. Journal of paediatrics and child health. 2012;48(3):242-6. Rush E, Reed P, McLennan S, Coppinger T, Simmons D, Graham D. A school-based obesity control programme: Project Energize. Two-year outcomes. The British journal of nutrition. 2012;107(4):581-7. Anaesthetics The academic Department of Anaesthesia is led by Prof. Jamie Sleigh and supported by Dr Logan Voss (Research Scientist), Dr John Barnard (Clinical Senior Lecturer/Clinical Anaesthetist), Dr Hugh Douglas (Clinical Senior Lecturer/Clinical Anaesthetist), Dr Martyn Harvey from the Emergency Department is also working closely with Professor Sleigh. The anaesthetic research group has interests in: Depth-of-anaesthesia monitoring and the detection of nociception while under general anaesthesia, and the modelling of anaesthesia, sleep, and seizures. The department is able to offer a broad-based clinical and neuroscience research environment for any prospective PhD and MD students. Professor Jamie Sleigh has supervised the following students within 2012:

1) Paul Timmings. PhD. 2011-2012. Assesment of change in EEG photosensitivity as a drug efficacy marker, using JME with lamotrigine and valproate as a model. 2) Allan Merry MD. 2010-2012. The use of conventional Non-steroid Analgesics for pain relief after surgery 3) Kyle Wang PhD 2010-2012. The Research of Nonlinear Dynamics Based Continuum Cortical Modelling. Waikato University. 4) Corinne Law MD Intraoperative titratability of opioids – Can electroencephalographic (EEG) monitoring help us predict how much to give? 2009-2012 University of Auckland 5) Nathaniel Chiang. PhD Tissue oxygenation and wound healing in vascular surgery. 2008-2012. University of Auckland National and international collaborative links have been further strengthened with the publication of several co-authored papers, and involvement in a number of new multicentre clinical trials. Current external organisation which the Department has research collaborations with include: University of Leiden UC Berkeley

WCS Annual Report 2012 Page 16 of 24

UC Stanford Imperial College University of Wisconsin (Madison) University of Otago University of Adelaide University of Melbourne Institute of Electrical Engineering, Yanshan University, Qinhuangdao, Hebei, China Publications Li D, Liang Z, Wang Y, Hagihira S, Sleigh JW, Li X. Parameter selection in permutation entropy for an electroencephalographic measure of isoflurane anesthetic drug effect. Journal of clinical monitoring and computing. 2013;27(2):113-23. Li D, Li X, Hagihira S, Sleigh JW. Cross-frequency coupling during isoflurane anaesthesia as revealed by electroencephalographic harmonic wavelet bicoherence. Br J Anaesth. 2013;110(3):409-19. Sleigh J. All hands on dex. Anaesthesia. 2012;67(11):1193-7 Sleigh J. Confound those damned confounders. Anaesth Intensive Care. 2012;40(4):593-4. Steyn-Ross ML, Steyn-Ross DA, Sleigh JW. Gap junctions modulate seizures in a mean-field model of general anesthesia for the cortex. Cognitive neurodynamics. 2012;6(3):215-25. Voss LJ, Baas CH, Hansson L, Steyn-Ross DA, Steyn-Ross M, Sleigh JW. Investigation into the effect of the general anaesthetics etomidate and ketamine on long-range coupling of population activity in the mouse neocortical slice. European journal of pharmacology. 2012;689(1-3):111-7. Kelz MB, Sleigh J. From the edge of oblivion: the dance between intrinsic neuronal currents and neuronal connectivity. Anesthesiology. 2012;116(5):977-9. Shalbaf R, Behnam H, Sleigh J, Voss L. Measuring the effects of sevoflurane on electroencephalogram using sample entropy. Acta anaesthesiologica Scandinavica. 2012;56(7):880-9. Cheeseman JF, Winnebeck EC, Millar CD, Kirkland LS, Sleigh J, Goodwin M, et al. General anesthesia alters time perception by phase shifting the circadian clock. Proceedings of the National Academy of Sciences of the United States of America. 2012;109(18):7061-6.

WCS Annual Report 2012 Page 17 of 24

Wang J, Li X, Lu C, Voss LJ, Barnard JP, Sleigh JW. Characteristics of evoked potential multiple EEG recordings in patients with chronic pain by means of parallel factor analysis. Computational and mathematical methods in medicine. 2012;(2012):Article ID 279560. Sanders RD, Tononi G, Laureys S, Sleigh JW. Unresponsiveness not equal unconsciousness. Anesthesiology. 2012;116(4):946-59. Shalbaf R, Behnam H, Sleigh JW, Voss LJ. Using the Hilbert-Huang transform to measure the electroencephalographic effect of propofol. Physiological measurement. 2012;33(2):271-85. Ongoing Research Studies: 1. Does anaesthesia steal time? (see Marsden fund). 2. Theoretical modelling of gap junctions (see Marsden fund). (With Professor H Kirsch (UCSF) and Drs Steyn-Ross) Research Grants / Funding 1) 2012. The James S. McDonnell Foundation. Probing the overlap between sleep and anesthesia to enhance human cognition. With Paul Garcia (Emery University, Atlanta) and Divya Chander (Standford University) $1,250,000. 2) 2012. Biopharma TRI 2012 Round 1. March 2012. With Prof Bill Denny. Short-acting analogues of ketamine as anaesthetics. $92,000.

Theatre nurse and Prof Jamie Sleigh - photograph supplied by Waikato District Health Board

WCS Annual Report 2012 Page 18 of 24

Psychiatry The Department of Psychological Medicine has an active research programme in Waikato led by Professor Graham Mellsop and Associate Professor David Menkes. Professor Mellsop continues his research in diagnostic/classification and was a member of the World Health Organisation ICD 11 expert group. New projects commenced included effectiveness issues, rather than efficacy, in the use of antipsychotic medication. He continued his collaboration with Dr Kahu McClintock on assessment tools appropriate for NZ Maori. He also continued to work with the MoH on the development of programmes for applying a case mix based analysis to the use of their PRIHMD data. Associate Professor David Menkes extended his work on drug treatments, pharmaceutical policy, and physical health in psychiatric patients.

Prof Graham Mellsop and A/P David Menkes - photograph supplied by Waikato Clinical School

Diesfeld K, Mellsop G. Mental Health Law of the People’s Republic of China: Inviting dialogue. The Shanghai Archives of Psychiatry. 2012;24(6):360-1. Mellsop G. Sustainability of the Royal Australian and New Zealand College of Psychiatrists exams. Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists. 2012;20(3):252-4. McClintock K, Tauroa R, Mellsop G. An examination of Child and Adolescent Mental Health Services for Maori rangatahi (youth). International Journal of

WCS Annual Report 2012 Page 19 of 24

Adolescence and Youth. 2012:1-8. McClintock K, Mellsop GW, Moeke-Maxwell T, Frampton C. Pilot of Te Tomokanga: A Child and Adolescent Mental Health Service Evaluation Tool for an Indigenous Population. International Indigenous. 2012;3:1-11. Mellsop GW, Clapham-Howard F. Utilising Psychiatric Diagnosis and Formulation in the Clinical Process. 2012. McClintock K, Mellsop G. An examination of child and adolescent mental health services for maori rangatahi (youth). International Journal of Adolescents and Youth. 2012. Mellsop G, Diesfeld K. Service Availability, compulsion, and compulsory hospitalisation. Shanghai Archives of Psychiatry. 2012;24(1):44-5. Kumar S, Dean P, Smith B, Mellsop GW. Which family--what therapy: Maori culture, families and family therapy in New Zealand. International review of psychiatry. 2012;24(2):99-105. Kumar S, Mellsop GW. Burnout: Gender Aspects in Burnout for Experts. 2012. McClintock K, Moeke-Maxwell T, Mellsop GW, Merry S. Appropriate Child and Adolescent Mental Health Services (CAMHS): Maori Caregivers Perspective. Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health. 2012;9:387-98 Phillips M, Chen H, Diesfeld K, Xie B, Cheng H, Mellsop G, et al. China’s new mental health law: reframing involuntary treatment. The American Journal of Psychiatry. 2012. Menkes DB, Lancaster K, Grant M, Marsh RW, Dean P, du Toit SA. Vitamin D status of psychiatric inpatients in New Zealand's Waikato region. BMC psychiatry. 2012;12:68. Glue P, Gale C, Menkes DB, Hung N. Evaluation of bioequivalence between clozapine suspension and tablet formulations : A multiple-dose, fed and fasted study. Clinical Drug Investigation. 2012;32:723-7 Mellsop GW, Macdonald J, El-Badri S, Menkes DB. Patient appraisal of psychiatric trainee interview skills. Academic Psychiatry. 2012; 36:374-9

Herxheimer A, Healy D, Menkes DB. Case histories as evidence. International Journal of Risk & Safety in Medicine. 2012;24:23-9.

WCS Annual Report 2012 Page 20 of 24

Menkes DB, Schaaber J, Reed T, Lexchin J. Whose interests lie behind new ‘consensus’? (rapid response). 2012. Braillon A, Bewley S, Herxheimer A, Mansfield P, Lexchin J, Menkes DB, et al. Marketing versus evidence-based medicine. Lancet. 2012;380(9839):340. Menkes DB. Vitamin D: don't forget mental health. Bmj. 2012;345:e5710.

Dr Steven Lillis & Dr Veronique Gibbons- photograph supplied by Veronique Gibbons

General Practice and Rural Health Research within the department has a number of strands including Mental Health, Diabetes, Heart Failure, Thyroid Disease, Maori Health (chronic disease and cancer) and Medical Education. Research has been conducted by Professor Ross Lawrenson, and Dr Veronique Gibbons (Research Fellow). Much of this research has been in conjunction with local General Practitioners. Dr Fraser Hodgson, Senior Lecturer in General Practice, graduated with a Masters in Medical Science with a portfolio - PSA screening in general practice. Dr Gibbons and Dr Steven Lillis (former Senior Lecturer in General Practice supervised by Prof Ross Lawrenson) were awarded their PhDs in the Autumn graduation. The department completed work in 2012 in collaboration with Te Puna Oranga (Māori Health Service), Waikato DHB on HRC-funded project ‘Oranga Tane Māori'. The department continues on an HRC-funded study looking at costs and complications of prostate cancer.

WCS Annual Report 2012 Page 21 of 24

The Department was also involved in the GPEP programme of the NZ Royal College of General Practitioners which saw 20 registrars receiving research training. Publications Gibbons V, Lawrenson R, Sleigh P, Yarndley T, Conaglen JV. Investigating the pathways in primary practice leading to the diagnosis of central hypothyroidism. N Z Med J. 2012;125(1364):83-90. Hodgson F, Obertova Z, Brown C, Lawrenson R. PSA testing in general practice. Journal of primary health care. 2012;4(3):199-204. Obertova Z, Brown C, Holmes M, Lawrenson R. Prostate cancer incidence and mortality in rural men--a systematic review of the literature. Rural and remote health. 2012;12(2):2039.

Dr Anita Bell - photograph supplied by Waikato District Health Board

Public Health and Sexual Health Dr Anita Bell, Public Health Physician at Waikato and Dr Richard Wall, a Public Health Medicine Registrar in Auckland, have collaborated on research into heart failure diagnosis and treatment at Waikato Hospital. Dr Jane Morgan, consultant in public health, Honorary Senior Lecturer in Sexual Health, has been completing her MD Thesis on Epidemiology, screening and management of Chlamydia trachomatis infection in New Zealand. Publications Morgan J, Donnell A, Bell A. Does a clinical guideline change chlamydia testing? . Journal of primary health care. 2012;4(1):45-51.

WCS Annual Report 2012 Page 22 of 24

Cowie G, Bell A. A retrospective review of notified human leptospirosis cases in the Waikato region of New Zealand, 2004 to 2010. N Z Med J. 2012;125(1358):20-8. Dawson KL, Bell A, Kawakami RP, Coley K, Yates G, Collins DM. Transmission of Mycobacterium orygis (M. tuberculosis complex species) from a tuberculosis patient to a dairy cow in New Zealand. Journal of clinical microbiology. 2012;50(9):3136-8. Psutka R, Priest P, Dickson N, Connor J, Azariah S, Kennedy J, et al. Sexual health and the Rugby World Cup 2011: a cross-sectional study of sexual health clinics in New Zealand. Sex Health. 2012;9(5):466-71. Nursing Dr Jacquie Kidd, Mrs Kathy Shaw and Mrs Kathryn Blakey are involved in the postgraduate teaching and Masters Supervision of over 120 nurses from the Waikato DHB and the Midlands region. Jacquie is principal investigator on a Ministry of Health/Health Research Council study ‘Palliative Care, Health Literacy, Māori Communities and Health Services’, and is co-investigator a number of studies in collaboration with: Ministry of Health/Mental Health Foundation ‘Stories of Success: Mental Health Service Users’ Experiences of Social Inclusion in Aotearoa New Zealand’; Te Pou ‘Scoping Strategies to Reduce Seclusion for Maori in Mental Health Care’; and, Te Whare Kura, University of Auckland ‘An exploration of Te Kooti Rangatahi (problem solving courts for Māori youth) in Aotearoa’. Kathy is co-investigating a study on the ‘Evaluation of postgraduate education for graduate nurses and experienced nurses’ in Waikato. Publications Sheridan NF, Kenealy TW, Kidd JD, Schmidt-Busby JI, Hand JE, Raphael DL, et al. Patients' engagement in primary care: powerlessness and compounding jeopardy. A qualitative study. Health expectations: an international journal of public participation in health care and health policy. 2012.

WCS Annual Report 2012 Page 23 of 24

Summer Students The Waikato Clinical School offers ‘Summer Studentships’ each year. This program is managed by Assoc Prof John V Conaglen. In 2012 we awarded 11 summer studentships which were mostly funded by the Waikato DHB.

Supervisor Project Title Student Name

Dr Janice Wong Clinical usefulness of endobronchial ultrasound (EBUS)

Haylee Boyens

Dr Eskandarain Shafuddin

Acute exacerbations in chronic obstructive lung disease: Waikato prospective cohort study- 5 year follow up

Manisha Cooray

Dr Veronica Crawford

Acromegaly and impact of body image on quality of life

Dennis De Jong

Dr Veronique Gibbons

Does GP administration of IV antibiotics for cellulitis impact on cellulitis hospitalisation rates?”

Charles Heald

Prof Jamie Sleigh EEG patterns, responsiveness and pain during recovery from genera; anaesthesia

Sam Illing

Dr Udaya Samarakkody

Outcome and impact of gastrostomy on the health and well-being of the children with feeding difficulties

Mosese Karalus

Dr Barry Smith An assessment of the patterns and correlates of rheumatic fever (RF) discharges from Lakes DHB

Sean Lewis

Dr Mark Davis Is post-cardiothoracic surgery inpatient echocardiogram necessary or not?

Nina Luo

Dr Barry Smith Discharge planning as a factor in the decline in the rates of asthma ASH patients aged 0-4 years

Natalie Ron

Dr Arun Nair,

Intestinal colonisation patterns in very low birth weight pre-term infants”

Varun Thirayan

Dr Marianne Elston

Evaluation of thyroid function and TSH receptor antibody levels in pregnant women after definitive treatment for Graves’ disease

Kelson Tu’akoi

WCS Annual Report 2012 Page 24 of 24

Waikato Clinical Skills and Simulation Centre We are nearing the end of another busy and successful year with an increasing number of courses and workshops for a wide range of health professionals. Highlights for the year include:

June Trainee Intern CORE Resuscitation and Procedural Skills weeks ACME course for FACEMS

Midland Health Network Practical Skills weekend workshops for Practice Nurses covering suturing, IV therapy, wound care and ECG understanding

Two three-day APLS (Paediatric Life Support) courses and two three-day EMST (Trauma) courses for registrars from around New Zealand

Grassroots (rural medical and nursing students) practical skills weekend, and an interest day for Year 13 students from rural secondary Campuses with an interest in pursuing a career in health

Nine Newborn Life Support courses for midwives Purchase and extensive use of our new SimMan 3G wireless human

patient simulator – some in-situ in the new Emergency Dept and assisting paramedic training in the back of an ambulance

Over 200 NZRC CORE resuscitation courses for many different groups Continuing education sessions for GPs and Practice nurses Regular simulation sessions for ICU, ED, CCU, PACU, Ward 14,

Anaesthetics and Wintec Rob Sinclair, Director of the Skills Centre, would like to acknowledge and thank all the teaching staff for their excellent contributions and enthusiasm in helping to make the centre an on-going success and a valuable resource for all our health professionals - with special mention to Kevin Nation and Renee McKeany for their continued interest, innovation and extra commitment to the centre. WCS Administration Current WCS meetings/committees include; - WCS Executive meetings – 6 weekly - WCS Faculty meeting – a meeting of all clinical staff 4 times a year Administration Staff - School Manager - Personal Assistant to Assistant Dean of School - Student Administrator/Secretary - Student Administrator/Secretary