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Issue

Vol 131 No 1483: 5 October 2018

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Issue Summary

SUMMARY

Livestock-related injuries in the Midland region of New Zealand

Mischa Tosswill, Matthew Roskruge, Alastair Smith, Grant Christey

Agriculture is a major industry in New Zealand and remains one of the most dangerous industries worldwide. We have used data from the Midland Trauma Registry to determine the extent of livestock-related injuries across a large area of New Zealand to determine who is most at risk, causes and types of injuries, as well as direct hospital costs.

SUMMARY

Use of tranexamic acid in trauma patients requiring massive transfusion protocol activation: an audit in a major trauma centre in New Zealand

Nicholas Chapman

Tranexamic acid (TXA) has been shown to play an important role in the early management of severe trauma. No guidelines currently exist for its use in Canterbury District Health Board in the context of trauma and pre-existing evidence shows that doctors are unfamiliar with the evidence base surrounding it. This audit was designed to investigate its use in this centre and compare against international protocols. TXA was found to be under-utilised and significant departures from best practice were found. In particular, delayed administration beyond the three-hour therapeutic window occurred in a quarter of patients, which has been previously shown to increase the risk of death from blood loss. While this study represents only a small sample of trauma patients, it raises the question of whether this pattern of use applies to the wider population of these patients, both in this centre and further afield.

SUMMARY

New Zealanders experiences and pathways to a diagnosis of bowel cancer: a cross-sectional descriptive study of a younger cohort

Zoe Windner, Sue Crengle, Brandon de Graaf, Ari Samaranayaka, Sarah Derrett

Bowel cancer is a significant health issue in New Zealand, with over 3,000 people diagnosed each year, but little was known about the process of diagnosis. We surveyed a small group, of mostly younger patients, to gain some insight into this process for the first time. Most of our sample first approached a layperson, then a general practitioner. The majority of our sample took over six months to reach diagnosis; this was more likely if aged under 60 years, without a tertiary qualification, or were diagnosed in the public sector. Our research is not representative of the whole population diagnosed with bowel cancer, but provides some early indicators and highlights the potential for improvement in the healthcare system.

SUMMARY

Audit of ethnicity data in the Waikato Hospital Patient Management System and Trauma Registry: pilot of the Hospital Ethnicity Data Audit Toolkit

Nina Scott, Helen Clark, Bridget Kool, Shanthi Ameratunga, Grant Christey, Donna Cormack

Eliminating unfair differences in life expectancy between Mori and non-Mori is something the New Zealand government has signed up to. Part of this involves fixing unwarranted variations in healthcare that exist across a range of pathways. For this, we need good-quality ethnicity data to figure out where healthcare needs improving. We found that one-quarter (24%) of trauma patients who self-identified as Mori were misclassified as New Zealand European. We did this by asking patients to self-identify their ethnicity using the census ethnicity question. This is important because hospital data is used for national planning and budgeting and we need good-quality ethnicity data to guide efforts to implement the necessary steps for achieving equity.

SUMMARY

Equine-related injuries requiring hospitalisation in the Midland Region of New Zealand: a continuous five-year review

Amy R Jones, Alastair Smith, Grant Christey

The study has identified the demography, injury types, risk factors and outcomes for equine-related injuries in the Midland Region of New Zealand. Indications are that the severity of such injuries may be less than previously reported. However, the volumes and costs of injury represent a significant burden on the health system, individuals and communities. More detailed understanding of causative factors will allow targeting of prevention strategies to address high-risk activities and demographic groups.

SUMMARY

Alcohol-related emergency department attendances after the introduction of the Sale and Supply of Alcohol Act 2012

Kate Ford, James Foulds, Oliver Coleman, Michael Ardagh, Scott Pearson, Nicolas Droste, Giles Newton-Howes, J Douglas Sellman

Medical problems arising after alcohol use are a major cause of people needing to attend their local emergency department. A new law introduced in New Zealand (The Sale and Supply of Alcohol Act 2012) was intended to reduce the amount of harm due to alcohol. We found that there had been little change in the patterns of alcohol-related emergency department attendances in Christchurch after the new law came into effect. Most people who came to the emergency department because of a medical problem after drinking had bought their alcohol at a supermarket or liquor store, and had consumed their last drink at a private location.

SUMMARY

Conflict of interest and alcohol discourse a new face but familiar messages

Sally Casswell

The launch of a new alcohol industry body, the Alcohol Beverages Council, provides an active voice in the media debate on alcohol policy in New Zealand. The Council s messages are the usual ones offered by the alcohol industry and include erroneous statements about evidence-based policies. At the global level these messages, in the context of corporate social responsibility and lobbying activities, have been successful in subverting effective policy. A similar lack of policy implementation has happened in New Zealand. Underpinning the industry lobbying is the need to protect their sales and profits, 46% of which, in New Zealand, are derived from very heavy drinking occasions. It is important policy makers and media recognise the conflict of interest inherent in these messages.

ALL ARTICLES
SUMMARY

Changing trauma systems and outcomes as advances in medicine and collection of data improve

Christopher Wakeman, Melanie Evans

Livestock-related injuries in the Midland region of New Zealand

Mischa Tosswill, Matthew Roskruge, Alastair Smith, Grant Christey

Use of tranexamic acid in trauma patients requiring massive transfusion protocol activation: an audit in a major trauma centre in New Zealand

Nicholas Chapman

New Zealanders experiences and pathways to a diagnosis of bowel cancer: a cross-sectional descriptive study of a younger cohort

Zoe Windner, Sue Crengle, Brandon de Graaf, Ari Samaranayaka, Sarah Derrett

Audit of ethnicity data in the Waikato Hospital Patient Management System and Trauma Registry: pilot of the Hospital Ethnicity Data Audit Toolkit

Nina Scott, Helen Clark, Bridget Kool, Shanthi Ameratunga, Grant Christey, Donna Cormack

Surgical aortic valve replacement for valve-in-valve trans-catheter aortic valve dysfunction in the patient with a small aortic annulus

Andrei M Beliaev, Mark WI Webster, Sally C Greaves, James T Stewart, David A Haydock

Equine-related injuries requiring hospitalisation in the Midland Region of New Zealand: a continuous five-year review

Amy R Jones, Alastair Smith, Grant Christey

Colloidal silver optic neuropathy

Samuel J Newlands, Tom D Betts, Rebecca R Stack

An Obscure Nervous Case

By Dr. Ritchie

Alcohol-related emergency department attendances after the introduction of the Sale and Supply of Alcohol Act 2012

Kate Ford, James Foulds, Oliver Coleman, Michael Ardagh, Scott Pearson, Nicolas Droste, Giles Newton-Howes, J Douglas Sellman

Alzheimer s disease research: the future of BACE inhibitors

Conflict of interest and alcohol discourse a new face but familiar messages

Sally Casswell

SUMMARY

Livestock-related injuries in the Midland region of New Zealand

Mischa Tosswill, Matthew Roskruge, Alastair Smith, Grant Christey

Agriculture is a major industry in New Zealand and remains one of the most dangerous industries worldwide. We have used data from the Midland Trauma Registry to determine the extent of livestock-related injuries across a large area of New Zealand to determine who is most at risk, causes and types of injuries, as well as direct hospital costs.

SUMMARY

Use of tranexamic acid in trauma patients requiring massive transfusion protocol activation: an audit in a major trauma centre in New Zealand

Nicholas Chapman

Tranexamic acid (TXA) has been shown to play an important role in the early management of severe trauma. No guidelines currently exist for its use in Canterbury District Health Board in the context of trauma and pre-existing evidence shows that doctors are unfamiliar with the evidence base surrounding it. This audit was designed to investigate its use in this centre and compare against international protocols. TXA was found to be under-utilised and significant departures from best practice were found. In particular, delayed administration beyond the three-hour therapeutic window occurred in a quarter of patients, which has been previously shown to increase the risk of death from blood loss. While this study represents only a small sample of trauma patients, it raises the question of whether this pattern of use applies to the wider population of these patients, both in this centre and further afield.

SUMMARY

New Zealanders experiences and pathways to a diagnosis of bowel cancer: a cross-sectional descriptive study of a younger cohort

Zoe Windner, Sue Crengle, Brandon de Graaf, Ari Samaranayaka, Sarah Derrett

Bowel cancer is a significant health issue in New Zealand, with over 3,000 people diagnosed each year, but little was known about the process of diagnosis. We surveyed a small group, of mostly younger patients, to gain some insight into this process for the first time. Most of our sample first approached a layperson, then a general practitioner. The majority of our sample took over six months to reach diagnosis; this was more likely if aged under 60 years, without a tertiary qualification, or were diagnosed in the public sector. Our research is not representative of the whole population diagnosed with bowel cancer, but provides some early indicators and highlights the potential for improvement in the healthcare system.

SUMMARY

Audit of ethnicity data in the Waikato Hospital Patient Management System and Trauma Registry: pilot of the Hospital Ethnicity Data Audit Toolkit

Nina Scott, Helen Clark, Bridget Kool, Shanthi Ameratunga, Grant Christey, Donna Cormack

Eliminating unfair differences in life expectancy between Mori and non-Mori is something the New Zealand government has signed up to. Part of this involves fixing unwarranted variations in healthcare that exist across a range of pathways. For this, we need good-quality ethnicity data to figure out where healthcare needs improving. We found that one-quarter (24%) of trauma patients who self-identified as Mori were misclassified as New Zealand European. We did this by asking patients to self-identify their ethnicity using the census ethnicity question. This is important because hospital data is used for national planning and budgeting and we need good-quality ethnicity data to guide efforts to implement the necessary steps for achieving equity.

SUMMARY

Equine-related injuries requiring hospitalisation in the Midland Region of New Zealand: a continuous five-year review

Amy R Jones, Alastair Smith, Grant Christey

The study has identified the demography, injury types, risk factors and outcomes for equine-related injuries in the Midland Region of New Zealand. Indications are that the severity of such injuries may be less than previously reported. However, the volumes and costs of injury represent a significant burden on the health system, individuals and communities. More detailed understanding of causative factors will allow targeting of prevention strategies to address high-risk activities and demographic groups.

SUMMARY

Alcohol-related emergency department attendances after the introduction of the Sale and Supply of Alcohol Act 2012

Kate Ford, James Foulds, Oliver Coleman, Michael Ardagh, Scott Pearson, Nicolas Droste, Giles Newton-Howes, J Douglas Sellman

Medical problems arising after alcohol use are a major cause of people needing to attend their local emergency department. A new law introduced in New Zealand (The Sale and Supply of Alcohol Act 2012) was intended to reduce the amount of harm due to alcohol. We found that there had been little change in the patterns of alcohol-related emergency department attendances in Christchurch after the new law came into effect. Most people who came to the emergency department because of a medical problem after drinking had bought their alcohol at a supermarket or liquor store, and had consumed their last drink at a private location.

SUMMARY

Conflict of interest and alcohol discourse a new face but familiar messages

Sally Casswell

The launch of a new alcohol industry body, the Alcohol Beverages Council, provides an active voice in the media debate on alcohol policy in New Zealand. The Council s messages are the usual ones offered by the alcohol industry and include erroneous statements about evidence-based policies. At the global level these messages, in the context of corporate social responsibility and lobbying activities, have been successful in subverting effective policy. A similar lack of policy implementation has happened in New Zealand. Underpinning the industry lobbying is the need to protect their sales and profits, 46% of which, in New Zealand, are derived from very heavy drinking occasions. It is important policy makers and media recognise the conflict of interest inherent in these messages.

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