The principal scientific journal for the profession in New Zealand

Rohan Lynham, Matthew McGuinness, Christopher Harmston

Trauma teams in Aotearoa New Zealand—a national survey

Within New Zealand, there are three tiers of trauma provision, tertiary trauma centres, regional trauma hospitals and smaller rural hospitals, which would often be bypassed in the incidence of major trauma.

Sarah Gerritsen, Bruce Kidd, Magda Rosin, Stephanie Shen, Sally Mackay, Lisa Te Morenga, Cliona Ni Mhurchu

2021 Assessment of New Zealand district health boards’ institutional healthy food and drink policies: the HealthY Policy Evaluation (HYPE) study

An institutional nutrition policy can create more accessible and affordable healthy food and drinks, thereby positively influencing the dietary intake and preferences of staff and visitors, and ultimately decreasing nutrition-related chronic diseases.

Shaye Seefried, Kim Chin-Goh, Vahe Sahakian, Nicholas Lightfoot, Matthew Boyle

Paediatric forearm fractures manipulated in the emergency department: incidence and risk factors for re-manipulation under general anaesthesia

Forearm fractures are among the most common injuries in children, accounting for 45% of all childhood fractures and 62% of upper limb fractures. Treatment upon presentation to the emergency department (ED) routinely involves the use of procedural sedation, closed reduction, and casting. Subsequent re-manipulation under general anaesthetic (GA) is at times required when the initial reduction is inadequate.

Alice Alsweiler, Alice Rogan, Emma Carlin, Brad Peckler

Cruise ship patient presentation, admission, and intervention rates to the emergency department

New Zealand welcomes 322,000 tourists and 93,000 crew members annually from cruise ships. Prior to the COVID-19 pandemic, cruise ship numbers were rising yearly and contributing nearly $600 million to the New Zealand economy annually. Inevitably, some of these visitors require medical care for minor or major ailments. Modern cruise ships often have a medical team on board and varying access to investigations and treatment.

Marella Bedggood, Shirley Walton, Mayan Bedggood

Psychiatric hospitalisation before and after commencing long-acting injectable antipsychotic medication: a mirror-image study

Administration of antipsychotic medication in long-acting injectable (LAI) slow release formulations (also called depot antipsychotics) allows doses to be administered in the form of an intramuscular injection every two to four weeks instead of daily oral dosing, ensuring consistent medication delivery and more accurate monitoring of treatment adherence.

Lucy Barber, Rosemary Lane, Linda Holmes, Ngaire Murray, James K Hamill

Surgical smoke: how an issue in healthcare fits a planetary health framework

Exposure to surgical smoke has been linked to acute adverse health effects in healthcare workers including headaches, nausea, cough, and irritation of the eye, nose and throat.

Simon Thornley, Gerhard Sundborn, Daniel Engelman, Rachel Roskvist, Maryann Heather, Cielo Pasay, Roger Marshall, James McCarthy

High prevalence of scabies in Auckland pre-schools

Recent evidence indicates that scabies may play a more important role in the aetiology of various important diseases of childhood than has been appreciated. One study links scabies infestation with bacterial skin infection, particularly cellulitis and abscess. Scabies has also been implicated in the causation of kidney disease through post-streptococcal glomerulonephritis, and mounting evidence suggests a link with acute rheumatic fever.

Ryan Gage, Tim Chambers, Moira Smith, Christina McKerchar, Viliami Puloka, Amber Pearson, Ichiro Kawachi, Louise Signal

Children’s perspectives on the wicked problem of child poverty in Aotearoa New Zealand: a wearable camera study

Poverty is a significant health and equity issue in Aotearoa New Zealand. Like many developed countries, poverty rates in Aotearoa New Zealand have been defined as the percentage of households that have disposable income less than 50% of the national median after housing costs.

Wendy He, Alexandra Sorhage, Nichola C Wilson, N Susan Stott

Utility of data linkage for orthopaedic service planning in the paediatric population with cerebral palsy at Starship Children’s Hospital

Patients with CP have ongoing activity limitations and require multiple clinical services over a lifetime, particularly during childhood and adolescence. Information regarding the types and frequency of procedures performed in these children and knowledge of their demographic and clinical profiles would be helpful for service planning, including theatre space and rehabilitation needs, and ensuring consistency of health service delivery and outcomes.

David Brinson, Charlotte Ward, Cheryl Ford, Annabel Begg

Smokefree and vapefree streets: high levels of support from tourists, residents and businesses, implications for tourist-destination communities in New Zealand

Tobacco smoking remains a major cause of death and disability around the world, as well as a major contributor to health inequities. Many countries have progressively implemented strong tobacco control policies and legislation to protect present and future generations from the considerable health, economic, social, and environmental impacts of tobacco.

Philip Bagshaw, Pauline Barnett, Susan Bagshaw

Unmet healthcare need and the significance of charity hospitals in Aotearoa New Zealand

The story of the Aotearoa New Zealand health system is one of early optimism, some success and then disappointment at the failure of the public sector to respond to the needs of the community.

Frank Frizelle, Kiki Maoate

NZMJ: under new ownership

The New Zealand Medical Journal (NZMJ) is now owned by the Pasifika Medical Association Group (PMAG).

Vol 135 No 1558: 15 July 2022

A new opportunity for a fairer, more equitable approach to alcohol supply—minus the marketing

Sally Casswell

A key issue the review must traverse is how can we ensure safe and responsible supply of alcohol while reducing the inequities in wellbeing and health to which alcohol significantly contributes.

Time for Rangatiratanga

Jonathan Koea

As July the first rolls around, in the time of renewal following Matariki, and the proposed revamp of the public health system is operationalised, Howard et al, in the current issue of the Journal, provide a timely reminder of the importance and responsibilities of clinical leadership in the health system.

Vol 135 No 1556: 10 June 2022

All the cancer you cannot see

Lutz Beckert, George Laking

Lung cancer is the leading cause of cancer death in New Zealand with 1,700 deaths each year. More New Zealanders die of lung cancer than of breast cancer, prostate cancer and melanoma combined. Between 2008–2017, lung cancer was diagnosed in 43:100,000 Māori and 13:100,000 non-Māori/non-Pacific New Zealanders; a number we need to keep in mind as we look at the information on lung cancer in this edition of the journal.

Vol 135 No 1555: 20 May 2022

From here to where: the continued metamorphosis of the NZMJ

Most of us are resistant to change as it requires some effort to adjust, and at times it feels uncomfortable. What we are familiar with is predictable and frequently reliable enough. Change challenges us and forces us to reassess what we think of as important. Change, however, is inevitable, and is the only way to see improvement.

Vol 135 No 1554: 6 May 2022

Trauma, COVID-19 and healthcare investment

Ian Civil

Just over two years have passed since the first cases of COVID-19 were recognised in New Zealand. In that time, there have been a range of restrictions and lockdowns during which individuals’ ability to travel and engage in a range of work-related and personal activities have been severely constrained.

Matt Boyd, Michael G Baker, Cassidy Nelson, Nick Wilson

The 2021 Global Health Security (GHS) Index: Aotearoa New Zealand’s improving capacity to manage biological threats must now be consolidated

The Global Health Security (GHS) Index was first published in 2019 by the Nuclear Threat Initiative (NTI), Johns Hopkins Centre for Health Security, and the Economist Intelligence Unit. It is a comprehensive, criteria-based assessment of health security capabilities across 195 States Parties to the International Health Regulations. The metric encompasses six categories relevant to health security and biological threats: Prevent, Detect, Respond, Health, Norms, and Risk.

Chok G Chan, Ralph Stewart

The unexpected benefits of sodium glucose co-transporter 2 (SGLT2) Inhibitors

The sodium glucose co-transporter 2 (SGLT2) inhibitors were developed in the 1990s, over a century after an isolate from an apple tree bark was found to be glucosuric. The isolate, phlorizin, was found to inhibit active co-transport of sodium and glucose in the proximal kidney tubules and this was later modified to develop the first orally active SGLT2 inhibitor.

Tracy Chan, Walter van der Merwe, Janak R de Zoysa

Delay in funding of tolvaptan for polycystic kidney disease in Aotearoa New Zealand

Autosomal dominant polycystic kidney disease (ADPKD) is characterised by the formation and growth of multiple cysts within the kidney that distort and destroy the kidney structure and function.

Vol 135 No 1558: 15 July 2022

Innovation in Aotearoa New Zealand’s healthcare system—how to make it happen

Robyn Whittaker, Penny Andrew, Rosie Dobson, Dale Bramley

There are many different definitions of innovation, although most include the elements of novelty, application and benefit.[[1,2]] In health services, innovation can simply be doing something differently, and better than how it is generally done or has previously been done—it could be a new process, device, technology, system or service. It is not just having the idea of how to do something differently (the idea or invention) but also getting it embedded into standard clinical practice (the implementation).

Vol 135 No 1558: 15 July 2022

Did new treatments contribute to a decrease in melanoma deaths?

Kylie Mason, Liam Kelly, Christopher Jackson, Deborah Read, Barry Borman

Given these high melanoma rates and the link to an environmental exposure, melanoma incidence and mortality are routinely monitored as part of the Environmental Health Intelligence NZ (EHINZ) surveillance programme, which provides information for action on environmental health issues in New Zealand. Decreasing the burden of melanoma in New Zealand would have a substantial impact on the health of many New Zealanders.

Consent for teaching

Ben Gray

The issue of consent for student involvement with patient care was raised by the Cartwright Inquiry. Evidence was presented that medical students were required to perform vaginal examination on anaesthetised women without their knowledge or consent. As a result of the Inquiry, the Code of Health and Disability Consumer Rights (HDC Code) was established that includes rights on consent for teaching (Rights 5,6 and 7). There are concerns that this requirement is not being observed, and a Consensus Statement (CS) was developed by Auckland and Otago medical schools on informed consent for teaching.

Grant Howard, John Robson, Karina McHardy, Andrew Simpson, Iwona Stolarek, Lloyd McCann

Doctors as leaders and governors

The health system in Aotearoa New Zealand (Aotearoa NZ) is implementing a significant reform agenda derived from the Health and Disability System Review. Unique to the Aotearoa NZ context, a key challenge facing the system and central to the reform agenda is a drive to achieve equitable outcomes, particularly related to Māori, Pasifika, and disabled populations.

Geraldine FH McLeod, Anna Fenton, Bryony Manning, Andrea Insch, Joseph M Boden

Just because you can…does not mean you should: an examination of efficacy and potential harms from non-prescribed supplements taken by members of the Christchurch Health and Development Study at age 40

The development and sale of non-prescribed dietary supplements is a growing industry. According to Euromonitor (2020) the value of global retail sales of non-prescribed supplements increased by 105% between 2007 and 2021. New Zealand’s market grew by 72% during the same period from NZ$194.8 million to NZ$335.5 million. Global demand for supplements such as vitamins C and D, minerals and herbal supplements increased as the COVID-19 pandemic has worsened despite, in most cases, no scientific evidence that their consumption can directly combat SARS CoV-2.

Karim M Mahawish, Muir Wallace

A quality improvement project to improve access to stroke clot retrieval from a regional stroke centre

Stroke clot retrieval (SCR) in patients with large vessel occlusion (LVO) is associated with significantly reduced disability at 90 days compared with intravenous thrombolysis alone.

Trends in the service provision and patient outcomes from 2013 to 2021 at a regional stroke centre

Karim M Mahawish

At the service level, admission to stroke units, routine assessment for dysphagia, interdisciplinary team work, higher ratios of nursing staff to patients and stroke unit accreditation are all associated with improved outcomes.

Christopher Robert Giles Arthur, Renoh Chalakkal, Ben O’Keeffe

New Zealand’s first practical demonstration of the telemedicine system specific to ophthalmology: MedicMind teleophthalmology platform

A recently published review article in Clinical Ophthalmology has foresighted teleophthalmology to play a critical role in ophthalmology management.

Julie Bennett, Caroline Shorter, Amanda Kvalsvig, Lucy Telfar Barnard, Nick Wilson, Julian Crane, Jeroen Douwes, Chris Cunningham, Phoebe Taptiklis, Robyn Phipps, Bill Trompetter, Manfred Plagmann, Mikael Boulic, Jennifer Summers, Terri-Ann Berry, Michael G Baker, Philippa Howden-Chapman

Indoor air quality, largely neglected and in urgent need of a refresh

Despite people in high- and middle-income countries spending 85–90% of their time indoors, and adults inhaling 11,000 litres of air every day, the health impacts of indoor air quality in Aotearoa New Zealand are barely recognised by Government agencies.

Gareth Rivalland, Rosalie Stephens, Michael McCrystal

Current role of sentinel lymph node biopsy in early-stage melanoma

There has been significant evolution in the management of surgically resectable melanoma the past five years with the success of adjuvant therapy for stage 3, and more recently, high-risk stage 2 melanoma. In the context of these recent changes, the role of sentinel lymph node biopsy (SLNB), which has been debated for many years, has come under the spotlight again.

Vol 135 No 1555: 20 May 2022

The incidence of diabetic ketoacidosis associated with empagliflozin use in Aotearoa New Zealand: a preliminary review

Lynne Chepulis, An Yu, Ryan Paul

Diabetic ketoacidosis (DKA) is a life-threatening but largely preventable complication of diabetes, resulting from excess ketone production due to relative or absolute insulin deficiency. DKA is primarily associated with type 1 diabetes mellitus (T1D), but may also occur in end-stage type 2 diabetes mellitus (T2D), and in those treated with sodium-glucose cotransporter-2 inhibitors (SGLT2).

Vol 135 No 1550: 25 February 2022

This pākehā life: an unsettled memoir

Kaaren Mathias

This pākehā life: an unsettled memoir is a candid memoir by Alison Jones, who currently is a Professor in the Faculty of Education and Social Work at the University of Auckland in the school of Māori and Indigenous Education, Te Puna Wānanga.

Vol 134 No 1532: 26 March 2021

Perfection: The life and times of Sir William Manchester

Saxon Connor

I recently spent a weekend in Martinborough and as many people do spent some time browsing the local bookshop.

Vol 133 No 1527: 18 December 2020

From Southland to Surgery: A Journey around Values

Richard Acland

Professor John Morton has not only written an intriguing catalogue of the Christchurch surgical scene in the latter part of the 20th century, but has also provided a well-considered philosophy for medical care.

Vol 133 No 1521: 4 September 2020

My Life in Public Health

In the time of Covid, some of the superheroes of the health sector are the public health physicians. This book outlines the active and varied personal and professional life of one New Zealand public health physician.

Vol 132 No 1489: 1 February 2019

Mind That Child; A Medical Memoir

This a book that recounts the experience of the Auckland Starship’s paediatrician Dr Simon Rowley over his professional lifetime.

Vol 132 No 1488: 18 January 2019

Fat Off; the Right Way A clever and sustainable eating guide for weight loss and healthy living

Paul Anderson is a New Zealander who trained in general surgery and works part-time in Australia and part-time in New Zealand.

Vol 132 No 1488: 18 January 2019

The Art of Recovery: six personal journeys