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Issue

Vol 132 No 1496: 7 June 2019

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Issue Summary

SUMMARY

Nature and delivery of cardiac rehabilitation in New Zealand: are services equitable to other high-income countries?

Brendon H Roxburgh, Marta Supervia, Karam Turk-Adawi, Jocelyne R Benatar, Francisco Lopez Jimenez, Sherry L Grace

Cardiac rehabilitation (CR) is a cost-effective service to improve risk factors after a heart attack and/or cardiac surgery, reducing mortality and risk of rehospitalisation. We compared the nature of CR programs in New Zealand and with those of countries with similar incomes and health systems. We found New Zealand CR programmes had fewer types and number of staff, provided fewer sessions and were less comprehensive, compared to those in other high-income countries. New Zealand did well in providing alternate forms of CR, such as community based.

SUMMARY

The Before School Check (B4SC): reporting outcomes and referral rates for all New Zealand children

Noni Richards, David Reith, Michael Stitely, Alesha Smith

The Before School Check (B4SC) is a health and development screening programme for four-year-olds. It captures information on the height, weight, vision, hearing and emotional and physical development of over 90% of four-year-old children in New Zealand. We found that less than 5% of children had problems with emotional and physical development. We also found that children from socioeconomically disadvantaged areas were more likely to be referred for extra assessment.

SUMMARY

Dissonance in naming adiposity: a quantitative survey of naming preferences from a convenience sample of health professional and lay population in Aotearoa New Zealand

Caz Hales, Lesley Gray, Carol MacDonald, Gordon Purdie

This paper comprised 775 adult participants (330 health professionals, 440 non-health, five not specified) and is the first study of its kind in Aotearoa New Zealand to explore weight-related terminology. Communication has an essential role in the therapeutic relationship between patient and healthcare professionals (HCPs) where terminology used can significantly impact on an individual s perceptions of weight and experience of stigma. Weight or high BMI were the most preferred terms for describing excess adiposity for participants. There was a conflict in responses relating to the terms considered most blaming and those considered to be motivating terms to lose weight, which is perhaps unsurprising given the level of bias and stigma in relation to people with excess adiposity (fatness). Whichever term is selected, HCP-patient conversations need to be respectful, appropriate and support meaningful non-stigmatising dialogue.

SUMMARY

Can direct-to-consumer advertising of prescription drugs be effectively regulated?

Joel Lexchin, David B Menkes

The New Zealand government is currently considering a draft Therapeutic Products Bill and is posing the question about whether direct-to-consumer advertising (DTCA) of prescription drugs should be regulated or banned. Recent studies demonstrate that DTC ads in the US continue to be misleading and contain minimal if any educational value, despite governmental regulatory efforts. Self-regulation by industry is even more ineffective. Vulnerable population groups, eg, those with poorer self-reported health status, older, less educated, lower income and ethnic minorities and those with unhealthy lifestyles are most likely to be affected by DTCA. Since evidence has demon-strated that regulation has consistently failed to prevent the inappropriate promotion of prescrip-tion medicines, the conclusion is that DTCA should be banned.

SUMMARY

Early direct current cardioversion or ablation for atrial fibrillation or atrial flutter and acute decompensated heart failure

Fang Shawn Foo, Andrew Kerr, Ruvin Gabriel, David Heaven, Jen-Li Looi, Mayanna Lund, Jamie Voss, Timothy Sutton

Patients who present to hospital with heart failure and atrial arrhythmias (fast heart rhythms originating from the upper chambers of the heart) have traditionally been managed with medications to slow down the heart rate. We investigated the outcomes of patients having their heart rhythms restored to a normal rhythm with synchronised cardioversion (an electric shock to reset the heart rhythm) or with ablation (a procedure from within the heart to interrupt the electrical circuit). We found that this strategy had a relatively low rate of death and rehospitalisation for heart failure. Most patients also had significant improvement in heart function. A subgroup of patients appeared to do better with an ablation strategy compared with cardioversion.

SUMMARY

Predictors of non-attendance at outpatient endoscopy: a five-year multi-centre observational study from New Zealand

Mehul Lamba, Yassar Alamri, Paras Garg, Chris Frampton, David Rowbotham, Richard Gearry

Our study has sought to identify patient groups who are more likely to miss outpatient endoscopy appointments. We found that younger patients, male gender, people from socioeconomically deprived areas and Mori and Pacific peoples were much more likely to miss endoscopy appointments. Overall compliance with endoscopy appointments was greater in Canterbury compared to Auckland, likely due to different patient reminder systems used across both district health boards. While we have identified vulnerable population groups, further studies are needed to identify specific patient factors related to non-attendance to facilitate targeted intervention to improve compliance.

ALL ARTICLES
SUMMARY

Nature and delivery of cardiac rehabilitation in New Zealand: are services equitable to other high-income countries?

Brendon H Roxburgh, Marta Supervia, Karam Turk-Adawi, Jocelyne R Benatar, Francisco Lopez Jimenez, Sherry L Grace

Choosing Wisely means choosing equity

Belinda J Loring, Sue Ineson, Derek Sherwood, David Tipene-Leach

The Before School Check (B4SC): reporting outcomes and referral rates for all New Zealand children

Noni Richards, David Reith, Michael Stitely, Alesha Smith

Dissonance in naming adiposity: a quantitative survey of naming preferences from a convenience sample of health professional and lay population in Aotearoa New Zealand

Caz Hales, Lesley Gray, Carol MacDonald, Gordon Purdie

Mirror-image confusion: successful giant hiatus hernia repair in situs inversus totalis

Cheyaanthan Haran, Nicholas Fischer, Thomas Oliver, Mark Grant

Can direct-to-consumer advertising of prescription drugs be effectively regulated?

Joel Lexchin, David B Menkes

Ronald Rutherford Elvidge

Ron Jones, Dawn Elvidge

The McKinnon Medical Registration Case

Early direct current cardioversion or ablation for atrial fibrillation or atrial flutter and acute decompensated heart failure

Fang Shawn Foo, Andrew Kerr, Ruvin Gabriel, David Heaven, Jen-Li Looi, Mayanna Lund, Jamie Voss, Timothy Sutton

Firearms and lead

Marie Russell, Deborah Read, Hera Cook

George Salmond

Peter Crampton, Nick Wilson, Helen Bichan, John Martin

How long does a hip replacement last?

Predictors of non-attendance at outpatient endoscopy: a five-year multi-centre observational study from New Zealand

Mehul Lamba, Yassar Alamri, Paras Garg, Chris Frampton, David Rowbotham, Richard Gearry

SUMMARY

Nature and delivery of cardiac rehabilitation in New Zealand: are services equitable to other high-income countries?

Brendon H Roxburgh, Marta Supervia, Karam Turk-Adawi, Jocelyne R Benatar, Francisco Lopez Jimenez, Sherry L Grace

Cardiac rehabilitation (CR) is a cost-effective service to improve risk factors after a heart attack and/or cardiac surgery, reducing mortality and risk of rehospitalisation. We compared the nature of CR programs in New Zealand and with those of countries with similar incomes and health systems. We found New Zealand CR programmes had fewer types and number of staff, provided fewer sessions and were less comprehensive, compared to those in other high-income countries. New Zealand did well in providing alternate forms of CR, such as community based.

SUMMARY

The Before School Check (B4SC): reporting outcomes and referral rates for all New Zealand children

Noni Richards, David Reith, Michael Stitely, Alesha Smith

The Before School Check (B4SC) is a health and development screening programme for four-year-olds. It captures information on the height, weight, vision, hearing and emotional and physical development of over 90% of four-year-old children in New Zealand. We found that less than 5% of children had problems with emotional and physical development. We also found that children from socioeconomically disadvantaged areas were more likely to be referred for extra assessment.

SUMMARY

Dissonance in naming adiposity: a quantitative survey of naming preferences from a convenience sample of health professional and lay population in Aotearoa New Zealand

Caz Hales, Lesley Gray, Carol MacDonald, Gordon Purdie

This paper comprised 775 adult participants (330 health professionals, 440 non-health, five not specified) and is the first study of its kind in Aotearoa New Zealand to explore weight-related terminology. Communication has an essential role in the therapeutic relationship between patient and healthcare professionals (HCPs) where terminology used can significantly impact on an individual s perceptions of weight and experience of stigma. Weight or high BMI were the most preferred terms for describing excess adiposity for participants. There was a conflict in responses relating to the terms considered most blaming and those considered to be motivating terms to lose weight, which is perhaps unsurprising given the level of bias and stigma in relation to people with excess adiposity (fatness). Whichever term is selected, HCP-patient conversations need to be respectful, appropriate and support meaningful non-stigmatising dialogue.

SUMMARY

Can direct-to-consumer advertising of prescription drugs be effectively regulated?

Joel Lexchin, David B Menkes

The New Zealand government is currently considering a draft Therapeutic Products Bill and is posing the question about whether direct-to-consumer advertising (DTCA) of prescription drugs should be regulated or banned. Recent studies demonstrate that DTC ads in the US continue to be misleading and contain minimal if any educational value, despite governmental regulatory efforts. Self-regulation by industry is even more ineffective. Vulnerable population groups, eg, those with poorer self-reported health status, older, less educated, lower income and ethnic minorities and those with unhealthy lifestyles are most likely to be affected by DTCA. Since evidence has demon-strated that regulation has consistently failed to prevent the inappropriate promotion of prescrip-tion medicines, the conclusion is that DTCA should be banned.

SUMMARY

Early direct current cardioversion or ablation for atrial fibrillation or atrial flutter and acute decompensated heart failure

Fang Shawn Foo, Andrew Kerr, Ruvin Gabriel, David Heaven, Jen-Li Looi, Mayanna Lund, Jamie Voss, Timothy Sutton

Patients who present to hospital with heart failure and atrial arrhythmias (fast heart rhythms originating from the upper chambers of the heart) have traditionally been managed with medications to slow down the heart rate. We investigated the outcomes of patients having their heart rhythms restored to a normal rhythm with synchronised cardioversion (an electric shock to reset the heart rhythm) or with ablation (a procedure from within the heart to interrupt the electrical circuit). We found that this strategy had a relatively low rate of death and rehospitalisation for heart failure. Most patients also had significant improvement in heart function. A subgroup of patients appeared to do better with an ablation strategy compared with cardioversion.

SUMMARY

Predictors of non-attendance at outpatient endoscopy: a five-year multi-centre observational study from New Zealand

Mehul Lamba, Yassar Alamri, Paras Garg, Chris Frampton, David Rowbotham, Richard Gearry

Our study has sought to identify patient groups who are more likely to miss outpatient endoscopy appointments. We found that younger patients, male gender, people from socioeconomically deprived areas and Mori and Pacific peoples were much more likely to miss endoscopy appointments. Overall compliance with endoscopy appointments was greater in Canterbury compared to Auckland, likely due to different patient reminder systems used across both district health boards. While we have identified vulnerable population groups, further studies are needed to identify specific patient factors related to non-attendance to facilitate targeted intervention to improve compliance.

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