Journal of the New Zealand Medical Association, 25-May-2012, Vol 125 No 1355
This Issue in the Journal
Youth experiences of secondhand smoke exposure in New Zealand: evidence from 5 national surveys (2000 to 2008)
Louise Marsh, Rob McGee, Andrew Gray, Rhiannon Newcombe, Rose Patterson
Surveys with Year 11 students (mainly 14–15 year olds) from 2000 to 2008 found declining rates of secondhand smoke exposure for young people in their homes and while travelling in vehicles. However, 35% of young people are still being exposed to secondhand smoke in their homes and 32% in vehicles. Although smokefree homes are increasing, there is still much work needed to reduce the rates of secondhand smoke exposure for our young people, and especially Māori and Pacific young people.
Benchmarking benzodiazepines and antipsychotics in the last 24 hours of life
Brian Ensor, Daphne Cohen
The use of medications at the very end of life is known to be very variable internationally, particularly regarding medications that can be sedative. Hospices in NZ considered that we needed to find out what variation exists within this country, so that we can start to reflect on our own practice, with the goal of working out why we do what we do. At this stage it is simply finding out the range of current practice, there is no attempt to make any judgements about what is ‘correct’ prescribing,. There are some expected causes of variation, such as those patients who die in a hospice may have more medication needs than those who die in the community. However there is an additional range of complex factors which may be unique for each hospice, each community and for each patient. The requirements for medications, and the goals for end-of-life care, are variable between people. The important bottom line is that there should be some dialogue and negotiation between patient, family and health professionals about what the goals are, and how medications subserve these goals. This is part of prompting further discussion in NZ about how people wish to be cared for at the end of life.
Nurse titration clinics to achieve rapid control of blood pressure
Dominic Taylor, Veronica van der Merwe, Walter van der Merwe
High blood pressure (“Hypertension”) is the most common chronic disease and the most common remediable cause of death in the western world. We set up a clinic at North Shore Hospital, Waitemata DHB, to cope with the large number of patients being referred from their GP with difficult-to-control hypertension. The patients were seen by a specialist doctor at the first appointment, and subsequently by a specialist nurse, who gave lifestyle advice and altered medications. Patients were screened for secondary (for instance, hormone-related) causes of hypertension. The nurse clinic allowed us to see and treat more patients, and the patients gave universally good feedback about the care they received. The quality of treatment as measured by our blood pressure measurements and number of clinics required was the same as the previous clinic which was staffed solely by doctors.
Validation of the Edinburgh Postnatal Depression Scale (EPDS) as a screening tool for postnatal depression in Samoan and Tongan women living in New Zealand
Alec J Ekeroma, Bettina Ikenasio-Thorpe, Sara Weeks, Jesse Kokaua, Kasalanaita Puniani, Peter Stone, Siale A Foliaki
Depression after having a baby has been shown to be more common in Tongan than in Samoan women. A study was conducted in Middlemore Hospital to determine whether a questionnaire used routinely for screening for depression after childbirth (EPDS) should also be used in Samoan and Tongan women. The study showed that the questionnaire was acceptable and could identify about 80% of women with depression. The questionnaire should be used routinely by health workers.
Is it NICE to monitor lithium routinely?
Andrew McKean, Jane Vella-Brincat
Lithium is a mood stabiliser for the treatment of bipolar affective disorder. It has predictable toxicity at concentrations above the normal range. This study compares the monitoring of lithium blood concentrations in Canterbury, New Zealand to the current UK standard. The monitoring of lithium blood concentrations in Canterbury, New Zealand did not meet this standard which is in keeping with other published audits.
Trends in child and adolescent discharges at a New Zealand psychiatric inpatient unit between 1998 and 2007
Kirsten van Kessel, Elizabeth Myers, Sarah Stanley, Peter W Reed
Over the past decade, there has been an increase in the number of young people admitted to the regional adolescent psychiatric unit at Starship Hospital. In particular, there have been more admissions of young people with serious mental illness, such as psychosis. There has been a steady increase in the number of young Maori admitted, and psychosis was the most common diagnosis for Maori and Pacific Island patients in this child and adolescent psychiatric inpatient setting. The current unit was not designed for such large numbers of seriously unwell young people, and the resources have not increased to match the need.
Partner notification for sexually transmitted infections. Why can’t we talk about it? ((viewpoint article))
Bacterial sexually transmitted infections such as chlamydia are very common in New Zealand. It is very important that sexual contacts of people diagnosed with bacterial sexually transmitted infections are notified of their possible exposure to an infection and are tested and treated to reduce re-infection rates and onward transmission of infection. However many health practitioners are not well trained in carrying out partner notification or feel confident in managing this process. Some practitioners commonly prescribe medication for sexual contacts of their patients without a prior consultation but this practice is not legal in New Zealand and overseas research does not support the effectiveness of such an intervention. Research does support the effectiveness of training of GP practice nurses and the use of resources such as partner notification cards in achieving better partner notification outcomes in primary care within existing legal frameworks.
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