Kia Ora How Kiwis approach weight management and

Middlemore Hospital – Largest hospital in Manukau County (South Auckland) – 91, 000 patient

Topic of Interest Weight Management End-of-Life Care – Middlemore serves a significant portion of

Weight Management – Many similarities between obesity epidemic in United States and New Zealand

End-of-Life Care – 13% of all healthcare costs in the United States are spent

In Summary Weight Management End-of-Life Care – Like in the United States, New Zealand

Clinical Experiences – Anesthesia Induction – Airway management – IVs – Working with the

Cultural Experiences – Waitomo Glowworm Caves – Tongariro Alpine Crossing – Rotorua Geothermal Wonderland

References – "Childhood Obesity Plan. " Ministry of Health NZ. <http: //www. health. govt.

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Kia Ora: How Kiwis approach weight management and end-of-life care Whitney Kleinmann

Location, Location

Middlemore Hospital – Largest hospital in Manukau County (South Auckland) – 91, 000 patient admits per year – 354, 000 outpatient visits per year – Offers a wide range of secondary level care as well as select tertiary care in the fields of: – Orthopedics – Plastic surgery – Burns – Spinal injury – Renal dialysis – NICU

Topic of Interest Weight Management End-of-Life Care – Middlemore serves a significant portion of the Maori population in Auckland – Part of my anesthesia rotation involved spending time in the intensive care unit – Maori culture values weight as a sign of wealth – In New Zealand, the onus is on the physician to determine when further treatment is no longer helping the patient – Middlemore delivers 8, 000 babies per year – Most of the pregnant women I saw during my rotation were overweight or obese – This often resulted in an earlier transition to a palliative approach and hospice care

Weight Management – Many similarities between obesity epidemic in United States and New Zealand – Obesity rate in New Zealand is 31% – New Zealand Ministry of Health released 22 initiatives as part of its Childhood Obesity Plan – Many GP’s in New Zealand recognize importance of preconception and gestational weight management

End-of-Life Care – 13% of all healthcare costs in the United States are spent on the last year of life – There is greater awareness that palliative care should be incorporated earlier in disease processes and hospice should be more utilized – In New Zealand, patients with chronic, terminal illnesses are rarely admitted to intensive care units.

In Summary Weight Management End-of-Life Care – Like in the United States, New Zealand recognizes that there is an obesity epidemic. – Physicians in New Zealand understand that resources are finite, and they tend to take a more pragmatic approach to endof-life care – Emphasis should be placed on preconception and gestational weight management in order to reduce risks of childhood obesity. – Patients and their families should not be burdened with the decision to stop treatment when the physician decides it is no longer helping the patient

Clinical Experiences – Anesthesia Induction – Airway management – IVs – Working with the amazing anesthesiologists – or anesthetists are they’re called in New Zealand

Cultural Experiences – Waitomo Glowworm Caves – Tongariro Alpine Crossing – Rotorua Geothermal Wonderland – Cathedral Cove – Abel Tasman National Park – Roy’s Peak

Cathedral Cove

Roy’s Peak

References – "Childhood Obesity Plan. " Ministry of Health NZ. <http: //www. health. govt. nz/our-work/diseases-and-conditions/obesity/childhoodobesity-plan>. – Fieldwick, Diana, Alesha Smith, and Helen Paterson. "General Practitioners and Preconception Weight Management in New Zealand. " Australian and New Zealand Journal of Obstetrics and Gynaecology (2017), 10. 1111/ajo. 12609 – Groeneveld, E. Iris, J. Brian Cassel, Claudia Bausewein, Agnes Csikos, Malgorzata Krajnik, Karen Ryan, Dagny Faksvag Haugen, Steffen Eychmueller, Heike Gudat Keller, Simon Allan, Jeroen Hasselaar, Teresa Garcia-Baquero Merino, Kate Swetenham, Kym Piper, Carl Johan Furst, and Fliss Em Murtagh. "Funding Models in Palliative Care: Lessons from International Experience. " Palliative Medicine 31. 4 (2017): 296 -305. Web. – Hales C, et al. The challenges in caring for morbidly obese patients in Intensive Care: A focused ethnographic study. Aust Crit Care (2017), http: //dx. doi. org/10. 1016/j. aucc. 2017. 02. 070 – "Middlemore Hospital. " Healthpoint. <https: //www. healthpoint. co. nz/middlemore-hospital/>. – Morin, L. , R. Aubry, L. Frova, R. Macleod, D. M. Wilson, M. Loucka, A. Csikos, M. Ruiz-Ramos, M. Cardenas-Turanzas, Y. Rhee, J. Teno, J. Ohlen, L. Deliens, D. Houttekier, and J. Cohen. "Estimating the Need for Palliative Care at the Population Level: A Cross-national Study in 12 Countries. " Palliative Medicine (2016), 10. 1177/0269216316671280