Objectives: We aimed to examine patterns in smoking and electronic nicotine delivery system (ENDS) use over an extended period of time (up to 20 weeks) in people who smoked and who had never previously made a successful quit attempt using an ENDS. Design and setting: We conducted a longitudinal mixed-methods study in Dunedin, New Zealand, during 2018 and 2019. Participants: Purposively selected participants (N = 45; age (≥18 years), gender, ethnicities, cigarettes/day) who wished to quit smoking. Interventions: Participants were provided with a second-generation ENDS device (vape pen or starter “tank” device) at the start of their quit attempt, and asked to complete smartphone-based daily diary surveys assessing smoking and ENDS use. Outcome measures: Sunburst plots and a sequence plot were used to describe weekly and daily patterns of smoking and ENDS use (smoking only, ENDS use only, dual use, abstinent). Results: The most frequently reported movements among participants, classified according to their study week behaviour, occurred between dual use and exclusive ENDS use (and vice versa). A smaller group reported moving from dual use to exclusive smoking (and often back to dual use), and a small number reported moving between abstinence and different ENDS and smoked tobacco usage behaviours. Data visualisations focussing on those participants who had provided data during each of weeks 9–12 indicate that only a minority reported sustained dual use; instead, most participants indicated varied smoked tobacco and ENDS use, which included periods of dual use. Conclusions: The considerable variety observed within and between study participants suggests that high variability is typical rather than exceptional. Transitions from smoking to ENDS use may involve considerable periods of dual use, which is likely to be dynamic and potentially sustained over several months.

The number of researchers and clinicians using movement-evoked pain and sensitivity to movement-evoked pain to assess shoulder pain has increased. However, the intrarater test-retest reliability of movement-evoked pain and sensitivity to movement-evoked pain in people with rotator cuff-related shoulder pain (RCRSP) is still unknown. We examined the intrarater test-retest reliability of movement-evoked pain and sensitivity to movement-evoked pain in participants with RCRSP. Seventy-four participants with RCRSP performed five trials of active shoulder abduction to elicit pain under two experimental conditions: active shoulder abduction to the onset of pain and maximum range of motion (ROM). The primary outcome measures were pain intensity and ROM. Test-retest reliability of movement-evoked pain and sensitivity to movement-evoked pain was examined using intraclass correlation coefficient (ICC_3,1) and minimal detectable change (MDC₉₀). The reliability of movement-evoked pain under both experimental conditions was good to excellent (ICC: 0.81 to 0.95), while the reliability of sensitivity to movement-evoked pain was poor in both conditions (ICC≤0.45). The MDC₉₀ for pain intensity was 1.6 and 1.8 during shoulder abduction to the onset of pain and maximum ROM, respectively. The MDC₉₀ for ROM was 17.5° and 11.2° during shoulder abduction to the onset of pain and maximum ROM condition, respectively. This study confirms movement-evoked pain testing during active shoulder abduction to the onset of pain or maximum ROM condition is reliable to assess pain associated with movement in patients with RCRSP. The minimal detectable change score of movement-evoked pain can guide clinicians and researchers on how to interpret changes in these outcomes.

Evidence from multiple countries suggests poisons centres create value in several ways including the provision of expert clinical advice, decreased hospital length of stay and triage of exposures e...

Background: Despite an overt commitment to equity, health inequities are evident throughout Aotearoa New Zealand. A general practice electronic alert system was developed to notify clinicians about their patient’s risk of harm due to their pre-existing medical conditions or current medication. We aimed to determine whether there were any disparities in clinician action taken on the alert based on patient ethnicity or other demographic factors. Methods: Sixty-six New Zealand general practices from throughout New Zealand participated. Data were available for 1611 alerts detected for 1582 patients between 1 and 2018 and 1 July 2019. The primary outcome was whether action was taken following an alert or not. Logistic regression was used to assess if patients of one ethnicity group were more or less likely to have action taken. Potential confounders considered in the analyses include patient age, gender, ethnicity, socio-economic deprivation, number of long term diagnoses and number of long term medications. Results: No evidence of a difference was found in the odds of having action taken amongst ethnicity groups, however the estimated odds for Māori and Pasifika patients were lower compared to the European group (Māori OR 0.88, 95 %CI 0.63–1.22; Pasifika OR 0.88, 95 %CI 0.52–1.49). Females had significantly lower odds of having action taken compared to males (OR 0.76, 95 %CI 0.59–0.96). Conclusions: This analysis of data arising from a general practice electronic alert system in New Zealand found clinicians typically took action on those alerts. However, clinicians appear to take less action for women and Māori and Pasifika patients. Use of a targeted alert system has the potential to mitigate risk from medication-related harm. Recognising clinician biases may improve the equitability of health care provision.

Split-plot experimental data are often analyzed as if the data came from a completely randomized design. As is well known, ignoring the different levels of randomization and replication can lead to serious inferential errors. However, in some experiments, including many of the ocean global change experiments that motivated this research, variation between whole-plot experimental units may be small relative to variation between subplot units. Even though a factorial analysis will often perform poorly in general, in this special case it outperforms a split-plot analysis, providing narrower confidence intervals for treatment means and differences with coverage rates close to the desired level. The performance of the proposed model-averaged analysis was compared to a classical split-plot analysis via a simulation study, and its utility demonstrated for an ocean global change experiment examining growth and condition of a juvenile mussel species. In our simulation study, model-averaged confidence intervals for whole-plot treatment means or comparisons of means were up to 40% narrower than split-plot confidence intervals while maintaining close to nominal coverage rates. In our example experiment, we observed narrowing of up to 25%. We recommend model averaging as a preferred approach when variation between whole-plot experimental units is expected to be less than between subplot units, with a few caveats for studies with very few replicates.

Mobilization with movement (MWM) is commonly used to treat patients with rotator cuff-related shoulder pain (RCRSP). However, the evidence supporting MWM efficacy for improving range of motion (ROM) and pain in patients with RCRSP is limited. To assess the immediate effects of MWM on the angular onset of pain in patients with RCRSP. Sixty-three participants with RCRSP were randomized to receive 3 sets of 10 repetitions of MWM or sham MWM with a minute rest between each set. The angular onset of pain (primary outcome), and pain intensity at rest and during shoulder abduction to the onset of pain were measured at baseline, and after receiving the 1^st and 3^rd sets of 10 repetitions of interventions. Other secondary outcomes were measured at baseline and after receiving 3 sets of 10 repetitions of interventions or 1, 2, 3, 5, and 7 days after interventions. Compared with the sham MWM group, the MWM group had an additional improvement of 6.5° (95% CI -0.9, 13.9) and 13.7° (95% CI 6.3, 21.1) (from baseline) after receiving the 1^st and 3^rd sets of 10 repetitions of interventions, respectively. MWM improves the angular onset of pain after 3 sets of 10 repetitions of MWM in patients with RCRSP. This study provides preliminary support for the use of MWM in treating patients with RCRSP and provides some guidance for clinicians to decide the MWM dosage to be used in clinical practice.