ORCID Profile
0000-0002-3366-5629
Current Organisations
The University of Auckland
,
Waikato District Health Board
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Publisher: Wiley
Date: 25-08-2023
DOI: 10.1111/ANS.18671
Abstract: Sigmoid volvulus is rare in Western countries. Patients at risk of sigmoid volvulus are often older with significant co‐morbidity. Without sigmoid colectomy there is a high recurrence rate, but indications for surgery are controversial. A retrospective observational study was conducted by reviewing clinical records of patients admitted to Waikato Hospital 1 January 2000 to 1 January 2020 with a diagnosis of sigmoid volvulus. Patient characteristics, clinical features, investigations, management, and outcomes were recorded. One hundred and thirty‐two patients (87 male) were included with 203 volvulus episodes. Median age 76 years, median Charlson co‐morbidity index (CCI) 4. Median follow‐up 11 years. 44/132 (33.3%) had surgery during the index admission, two had elective surgery and the remainder had planned non‐operative management. 73/132 (55.3%) had surgery at any stage. 42/86 (48.8%) patients managed non‐operatively recurred 66.7% of recurrences were within 6 months. Forty‐three (32.6%) died within 12 months of index admission 28 (21.2%) died during an admission for volvulus. On univariate analysis higher age and abnormal vital signs were associated with inpatient and 12‐month mortality higher CCI was associated with 12‐month mortality. On multi‐variate analysis increasing age in years was associated with increased risk of death (HR 1.089 [1.052–1.128, P 0.001]). Normal vital signs at presentation were associated with decreased risk of death (HR 0.147 [0.065–0.334, P 0.001]). Sigmoid colectomy should be considered at index presentation with sigmoid volvulus. Half of patients managed non‐operatively recurred, with two‐thirds recurring within 6 months. The mortality rate remains high for subsequent volvulus episodes.
Publisher: Wiley
Date: 25-02-2022
DOI: 10.1111/ANS.17573
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2014
Publisher: SAGE Publications
Date: 12-01-2011
Abstract: Background: Many studies have looked at sources of stress in psychiatrists, yet the role played by different factors in the causation of burnout in psychiatrists remains unclear. We had two aims, first, to develop a predictive model for the onset of burnout. Second, we aimed to study the differences in the perception of what caused stress between psychiatrists who rated themselves high on Emotional Exhaustion compared to those who rated themselves as low on Emotional Exhaustion. Methods: A previously described questionnaire that identified stressors relevant to consultant psychiatrists was mailed out to 426 psychiatrists, with 240 replies. Scores on the Emotional Exhaustion dimension of the Maslach Burnout Inventory were available for 131 respondents. Results: Based on an earlier literature review, the Sources of Stress Questionnaire (SOS-Q) used in the study had 45 factors, categorized into predisposing, precipitating, perpetuating and protective factors for burnout in psychiatrists. Of these, factor analysis identified 11 non-correlated factors which were used in the final analysis of this study. Four factors emerged as associated with burnout in psychiatrists in New Zealand: too much work working long hours an aggressive administrative environment and lacking support from management. Two factors negatively correlated with Emotional Exhaustion were a high level of job satisfaction and/or enjoyment, and low pay compared to other countries. Conclusions: Most factors associated with burnout are preventable and can be managed jointly between psychiatrists and administrators. Service providers need to address burnout seriously.
Publisher: Wiley
Date: 06-01-2021
DOI: 10.1111/ANS.16531
Abstract: Clinical predictors of pathological response to chemoradiotherapy for rectal cancer can influence patient management including selection for organ preservation. This study aimed to identify clinical predictors at a tertiary referral hospital. A retrospective review of clinical records was undertaken after identifying all patients with stage 1–3 rectal cancer treated with long course chemoradiotherapy and total mesorectal excision from 2013 to 2018. Clinicopathological factors were recorded and multivariate analysis performed to identify predictors of pathological complete response (pCR) and good response (AJCC TRG 0–1). A total of 470 patients with rectal cancer were identified of which 164 met the inclusion criteria for the study. The pCR rate was 14.6% and good response (TRG 0–1) rate 43.7%. On univariate analysis, lower T stage, older age, node negative status, anterior tumour position and shorter tumour length on magnetic resonance imaging (MRI) were associated with good response (TRG 0–1). On univariate analysis cN stage, carcinoembryonic antigen and shorter tumour length on MRI were associated with pCR. On binary logistic regression shorter length on MRI and lower clinical nodal stage were predictive of pCR and lower body mass index, anterior tumour position and higher haemoglobin were predictive of good response (TRG 0–1). Anterior tumour position is newly identified as an independent predictor of good response (TRG 0–1) to nCRT for rectal cancer and this should be explored in future studies. Higher haemoglobin and lower body mass index were also independent predictors of good response (TRG 0–1) and optimisation of these factors should be considered when using neoadjuvant chemoradiotherapy for rectal cancer.
Publisher: Wiley
Date: 07-06-2023
DOI: 10.1111/ANS.18556
Abstract: Colorectal cancer (CRC) screening was introduced in Aotearoa New Zealand at Waitematā District Health Board (WDHB) in late 2011. This study reviewed patterns of disease, treatment received, and survival of patients with national bowel screening program (NBSP)‐detected CRC versus non‐NBSP patients at WDHB 2012–2019. Data collected retrospectively for all patients with adenocarcinoma of the colon or rectum at WDHB 2012–2019. Patient records were manually reviewed. Chi‐square, Fisher's exact test and the Mann Whitney U ‐test used as appropriate. Kaplan–Meier and Cox proportional hazards regression modelling for survival analysis. 1667 patients included (360 NBSP and 1307 non‐NBSP). 863 (51.8%) were male. Median age at diagnosis 73 years (range 21–100) NBSP patients were younger (median 68 vs. 76 years, P 0.001). NBSP patients had significantly lower T, N, M and overall TNM stage than non‐BSP patients. Median survival estimate on Kaplan–Meier analysis was 94 months for all patients. Statistically significant ( P 0.05) predictors of mortality on multi‐variate regression analysis included increasing overall TNM stage compared with stage I (stage II HR 1.63 (95% CI 1.14–2.34), stage III HR 2.86 (95% CI 2.03–4.03), stage IV HR 7.73 (95% CI 5.59–10.68)), diagnosis within NBSP (HR 0.51 (95% CI 0.37–0.71)), increasing age in years (HR 1.03 (95% CI 1.02–1.03)), urgent/emergency surgery (HR 1.66 (95% CI 1.36–2.01)) and formal resection of primary tumour (HR 0.31 (95% CI 0.25–0.38)). Patients diagnosed within the Aotearoa New Zealand NBSP were found to be younger and have earlier stage CRC. Diagnosis within the NBSP is an independent predictor of survival for patients with CRC.
Publisher: SAGE Publications
Date: 10-2007
DOI: 10.1080/10398560701439699
Abstract: Objective: We aimed to elucidate causative and protective factors associated with burnout in New Zealand psychiatrists, to identify signs and symptoms of the burnout syndrome, and to identify any difference in the perspectives of psychiatrists who scored high versus low on the emotional exhaustion (EE) subscale of the Maslach Burnout Inventory (MBI). Method: Twelve participants were randomly selected, six from each group of psychiatrists (high versus low EE). A face-to-face interview based on a semi-structured questionnaire was carried out with each participant. The interviews were recorded and transcribed verbatim. The transcriptions were manually analysed by two independent reviewers using a grounded theory approach for qualitative analysis. Results: Major features of burnout were changes in appearance, behaviour and mood. Causes of burnout identified were external, internal and interpersonal factors, and changing work environment. Protective factors associated with burnout included supportive relationships, extracurricular activities, variety in one's work, a positive attitude towards one's work and high job satisfaction. Conclusions: A preliminary profile of the burnout syndrome was established and has a potential role in the prevention of burnout in psychiatrists. Causative factors associated with burnout were identified and supported previous findings. Novel factors protective against burnout were suggested and require further investigation. No differences were apparent between the two subgroups of psychiatrists (high versus low EE).
Publisher: Wiley
Date: 07-10-2020
DOI: 10.1111/CODI.15365
Abstract: The optimal management strategy for patients with endoscopically resected malignant colorectal polyps (MCP) has yet to be defined. The aim of this study was to validate a published decision‐making tool, termed the Scottish Polyp Cancer Study (SPOCS) algorithm, on a large international population. The SPOCS algorithm allocates patients to risk groups based on just two variables: the polyp resection margin and the presence of lymphovascular invasion (LVI). The risk groups are termed low (clear margin, LVI absent), medium (clear margin, LVI present) or high (involved/non‐assessable margin). The International Polyp Cancer Collaborative was formed to validate the algorithm on data from Australia, Denmark, UK and New Zealand. In total, 1423 patients were included in the final dataset. 680/1423 (47.8%) underwent surgical resection and 108/680 (15.9%) had residual disease (luminal disease 8.8%, lymph node metastases 8.8%). The SPOCS algorithm classified 602 patients as low risk (in which 1.5% had residual disease), 198 patients as medium risk (in which 7.1% had residual disease) and 484 as high risk (in which 14.5% had residual disease) ( P 0.001, χ 2 test). Receiver operating characteristic curve analysis demonstrated good accuracy of the algorithm in predicting residual disease (area under the curve 0.732, 95% CI 0.687–0.778, P 0.001). When patients were designated as low risk, the negative predictive value was 98.5%. The SPOCS algorithm can be used to predict the risk of residual disease in patients with endoscopically resected MCPs. Surgery can be safely avoided in patients who have a clear margin of excision and no evidence of LVI.
Publisher: Informa UK Limited
Date: 14-01-2021
Publisher: Wiley
Date: 11-12-2016
DOI: 10.1111/ANS.12429
Abstract: Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the gastrointestinal tract and make up 1-2% of all gastrointestinal malignancies. Traditionally, the treatment of choice for primary disease is surgical resection however, no single surgeon or institution gets extensive exposure to these patients so appropriate decision-making is difficult, particularly since the introduction of the tyrosine kinase inhibitor imatinib, which has become an important additional management tool. All patients were diagnosed and treated for GISTs in Christchurch Hospital (Christchurch, New Zealand) between 1 January 2000 and 31 December 2010. We maintain a prospective database of all patients with GISTs. Data on clinical and histopathological variables, management and survival outcomes were recorded. These were then reviewed. There were 93 patients in this study. Fifty were women. Median age was 69 (interquartile range (IQR) 59-76) years. Fifty-one tumours were located in the stomach, 27 in the small bowel, six in the colon, three in the oesophagus, one in the rectum and five were extra-gastrointestinal. In total, 22 patients received imatinib therapy four patients with metastatic disease had imatinib as sole therapy. The median follow-up was 58 (IQR 30-90) months. The 5-year overall survival and disease-free survival (DFS) for the entire study population was 69% and 64%, respectively. The 5-year DFS was higher for all patients who have localized disease when compared with those who have metastatic disease (76% versus 28%, P-value 0.001). Surgery aiming at an R0 resection remains the mainstay of treatment. We propose the most effective way to grow the knowledge base in New Zealand is the establishment of a national register, thereby allowing better clinical decision-making by interpretation of a larger data set.
Publisher: Wiley
Date: 08-04-2017
DOI: 10.1111/ANS.13502
Abstract: The management of colorectal polyps containing a focus of malignancy is problematic, and the risks of under- and over-treatment must be balanced. The primary aim of this study was to describe the management and outcomes of patients with malignant polyps in the New Zealand population the secondary aim was to investigate prognostic factors. Retrospective review of relevant clinical records at five New Zealand District Health Boards. Out of the 414 patients identified, 51 patients were excluded because of the presence of other relevant colorectal pathology, leaving 363 patients for analysis. Of these, 182 had a polypectomy, and 181 had a bowel resection as definitive treatment. The overall 5-year survival was not altered with resection but was improved with re-excision of any form (repeat polypectomy or bowel resection). There were 110 rectal lesions and 253 colonic lesions. A total of 16% of patients who had resection after polypectomy were found to have residual cancer in the resected specimen. Ischaemic heart disease, chronic obstructive pulmonary disease and metastatic disease were found to negatively impact overall survival (P < 0.001). Resection was more likely to follow polypectomy if polypectomy margins were positive, fragmentation occurred for sessile lesions and for pedunculated lesions with a higher Haggitt level. Polypectomy is oncologically safe in selected patients. Re-excision improves overall survival and should be considered in patients with low comorbidity (American Society of Anesthesiologists score 1 and 2) and where there is concern about margins (sessile lesions and positive polypectomy margins). In the majority of patients, however, no residual disease is found.
Publisher: Wiley
Date: 07-2013
DOI: 10.1111/ANS.12237
Publisher: SAGE Publications
Date: 07-2007
Abstract: Objectives: To estimate the prevalence of burnout and the level of job satisfaction among New Zealand psychiatrists, and to ascertain relationships between socio-demographic variables, job satisfaction and burnout in the target population. Method: In phase one of the study a postal survey was mailed out to every practising psychiatrist on record as well as all doctors working in psychiatry without specialist qualifications (MOSS). Three questionnaires were used: a socio-demographic questionnaire, the Maslach Burnout Inventory (MBI) and a Job Diagnostic Survey (JSS). Regression analysis was performed on returned data sets using socio-demographic characteristics as explanatory variables and score components of the MBI and JDS as the outcome measures. Results: The results showed that the prevalence of burnout in New Zealand psychiatrists is cause for concern. Two-thirds of all psychiatrists described moderate to severely high levels of emotional exhaustion, with a similar proportion describing low levels of personal accomplishment. Depersonalisation did not appear to be a major problem in the population. Job satisfaction remained relatively high despite the high prevalence of burnout, although there was a relationship between burnout and job satisfaction scores. Conclusions: This study has demonstrated a high prevalence of burnout and factors associated with it among New Zealand psychiatrists. Further research is needed to ascertain why job satisfaction remains high in the presence of burnout, and factors predisposing to, or protective of, burnout.
Publisher: MDPI AG
Date: 05-10-2018
Abstract: Colorectal cancer (CRC) is the third most common cancer in the Western world, with one-third of cases located in the rectum. Preoperative radiotherapy is the standard of care for many patients with rectal cancer but has a highly variable response rate. The ability to predict response would be of great clinical utility. The response of cells to ionizing radiation is known to involve immediate damage to biomolecules and more sustained disruption of redox homeostasis leading to cell death. The peroxiredoxins are an important group of thiol-dependent antioxidants involved in protecting cells from oxidative stress and regulating signaling pathways involved in cellular responses to oxidative stress. All six human peroxiredoxins have shown increased expression in CRC and may be associated with clinicopathological features and tumor response to ionizing radiation. Peroxiredoxins can act as markers of oxidative stress in various biological systems but they have not been investigated in this capacity in CRC. As such, there is currently insufficient evidence to support the role of peroxiredoxins as clinical biomarkers, but it is an area worthy of investigation. Future research should focus on the in vivo response of rectal cancer to radiotherapy and the redox status of peroxiredoxins in rectal cancer cells, in order to predict response to radiotherapy. The peroxiredoxin system is also a potential therapeutic target for CRC.
Publisher: Springer Science and Business Media LLC
Date: 18-11-2010
DOI: 10.1007/S00467-009-1348-X
Abstract: Infants with mild postnatal renal dilatation but without vesicoureteral reflux pose a challenge. For how long and in what way should they be followed? From May 1989 to December 2006, we prospectively followed 1,795 pregnancies in which the foetal renal pelvis measured 4 mm or greater. Voiding cystourethrography (VCUG) and renal ultrasound were performed on 1,315 infants at 6 weeks of age. Our study group comprised 208 (167 male) infants with normal VCUG findings who had a renal pelvis of 6-11 mm. We followed them for 1-17 years (mean 11 years). Medical and radiological records were reviewed to determine any urinary symptoms and final outcome. They underwent, on average, four further imaging tests. The renal dilatation had resolved by 24 months in approximately 70%. Urinary tract infection (UTI) developed in 16 (8%). Calyceal dilatation was more likely in those developing UTI (P=0.02). Twenty-two (10.6%) had a radiologically demonstrated urinary tract abnormality. Of the five who had renal scarring or severe obstruction, four became symptomatic. Most infants with mild postnatal renal dilatation can be investigated with only one further sonogram at 24 months of age. Mild postnatal renal dilatation is associated with subsequent UTI or renal tract abnormality in 18%. Severe renal abnormality occurred in 2.4%.
Publisher: Wiley
Date: 04-2017
DOI: 10.1111/ANS.13064
Publisher: Wiley
Date: 28-03-2019
DOI: 10.1111/ANS.15074
Abstract: Colorectal cancer (CRC) is common and at least 80% of cases are sporadic, without any significant family history. Prognostication and treatment have been relatively empirical for what has become increasingly identified as a genetically heterogeneous disease. There are three main genetic pathways in sporadic CRC: the chromosomal instability pathway, the microsatellite instability pathway and the CpG island methylator phenotype pathway. There is significant overlap between these complex molecular pathways and this limits the clinical application of CRC genetics. Recent Australian and New Zealand guidelines recommend routine testing of mismatch repair (MMR) status for new cases of CRC and selective KRAS and BRAF testing on the basis of diagnostic, prognostic and therapeutic implications. It is important that all clinicians treating CRC have an understanding of the importance of and basis for identifying key genetic features of CRC. It is likely that in the future better molecular characterization such as that allowed by the consensus molecular subtype classification will allow improved prognostication and targeted therapy in order to deliver more personalized treatment for CRC.
Publisher: Springer Science and Business Media LLC
Date: 22-02-2008
DOI: 10.1007/S00127-008-0320-6
Abstract: To ascertain the presence, and describe the pattern and extent, of restrictive care practices in the treatment of mental health inpatients in a rural New Zealand unit. Retrospective data was anonymously extracted from patient records at Rotorua Hospital (Rotorua, New Zealand). Data sets were compiled from 300 consecutive patient admissions between January 2000 and December 2001. The demographic and diagnostic characteristics extracted were gender, age, ethnicity (Măori or non-Măori classification only), primary diagnosis, length of hospital stay, seclusion, medication on discharge, dosage of antipsychotic medication if given, referral to psychotherapy, voluntary/involuntary status on admission, and readmission rates. After controlling for other clinical variables, ethnicity was not associated with specific diagnoses, increased use of seclusion, and involuntary status on admission or higher readmission rates. Măori patients were more likely to receive antipsychotic medication and at higher doses than non-Măori. Măori were less likely to be referred to psychotherapy services and had shorter lengths of stay. There was no evidence of widespread restrictive care practices against Măori, although the disparities in antipsychotic prescription and psychotherapy referral suggest some restrictive care practices do exist. The use of specialist cultural teams in general mental health services may prevent restrictive care practices.
Publisher: Oxford University Press (OUP)
Date: 2022
DOI: 10.1093/JSCR/RJAB629
Abstract: Colorectal cancer (CRC) is the third most diagnosed malignancy in the Western world. Routine staging of CRC often identifies incidental lesions on cross-sectional imaging. Appropriate treatment is dependent on a correct histological diagnosis. Pancreatic Ductal Adenocarcinoma (PDAC) is a rarer and often devastating diagnosis for which the treatment pathway differs significantly to CRC. We report two rare cases: the first recorded case of PDAC with synchronous rectal metastasis and a case of an acute presentation with large bowel obstruction from synchronous colonic metastasis. Both cases presented a significant diagnostic challenge. The management of both cases would have been altered had the histological diagnosis been known prior to surgery. Clinicians treating CRC should be wary of incidental lesions on staging investigations as they rarely represent an occult extra-intestinal primary malignancy. Immunohistochemistry plays an important role in ascertaining the origin of gastrointestinal malignancy.
No related grants have been discovered for Jesse Fischer.