Vol 132 No 1501: 30 August 2019

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Issue Summary

Viewpoint

SUMMARY

Health effects of radiofrequency electromagnetic energy

Mark Elwood, Andrew W Wood

The issues of real or suspected health effects of radiofrequency fields, produced by cellphones, their base stations and many other devices, are complex and controversial. We believe that the most balanced and valid assessments are given by the extensive reports produced by reputable, multidisciplinary, expert groups, using established methods to assess all available published literature. These reports are freely available on websites. The scientific literature on these issues is enormous, particularly in animal and laboratory studies. Results claiming to show increased genetic damage or other biological effects are much more common in studies of low quality, whereas higher-quality studies predominantly show no significant effects. While there are many reports which in isolation suggests effects, there is no consistent evidence supporting important health effects caused by low intensities of radiofrequencies similar to those experienced by the general population. New studies need to be assessed carefully and replicated where possible.

Article

SUMMARY

The cost of electric-scooter related orthopaedic surgery

Jacob Munro, Paul Monk, Alex Campbell, Nicole Wong, Zaid Bahho

Electric scooters are a popular mode of transport for short-distance travel, particularly within the city. The orthopaedic department at Auckland City Hospital is seeing increasing numbers of injuries as a re-sult of their use that require operations. These injuries seen are often high-energy sorts of injuries usually seen in motor-vehicle accidents or falls from great heights. These injuries are adding to waiting times for other acute operations and represent a significant period of recovery and time off work.

Article

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Outpatient parenteral antimicrobial therapy (OPAT) in Christchurch: 18 years on

Steven T Chambers, Ari Basevi, Kate Gallagher, Amanda Carswell-Moyna, Heather Isenman, Alan Pithie, Simon Dalton, Sarah CL Metcalf

Outpatient parenteral antimicrobial therapy (OPAT) has become an established option for management infections requiring intravenous therapy and is now being used to manage more severe and complicated cases than when started 18 years ago. Demand has increased more than two and a half times. This has been managed by increased collaboration with district health nurses and virtual clinics to ensure patients were safe. Despite this some patients still need to be readmitted to hospital while on treatment and we need to more about why this happens.

Viewpoint

SUMMARY

Expediting cataract surgery in New Zealand is cost-effective for falls prevention and improving vision—so what might be the next steps?

Matt Boyd, Adeline Kho, Nick Wilson, Graham Wilson

Older people with cataracts are at increased risk of falling, and this can lead to serious injury. A recently published modelling study shows that expediting cataract surgery can reduce falls, improve vision and is good value for money. This begs the question of what more New Zealand could do to increase throughput of cataract procedures. We argue that the New Zealand public health system should consider prioritising the reduction of waiting times for cataract surgery by expediting cataract surgery through changes to the current scoring system and increasing throughput with more cases on each surgical list. There may also be some potential for cost reductions through enhanced bulk purchase by DHBs from private sector providers.

Article

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Is hook diathermy safe to dissect the mesoappendix in paediatric patients? A 10-year experience

Jenni Perrin, Philip Morreau, Vipul Upadhyay

Laparoscopic or keyhole surgery to remove the appendix in children is one of the most commonly performed emergency surgeries at Starship Children s Hospital. One of the methods of isolating and dissecting out the appendix is using a diathermy hook. By assessing the outcomes of 2,793 children under 15 years of age who had laparoscopic appendicectomy using hook diathermy alone, we have shown this to be a safe and effective method, with low rates of complications and conversion to open operation.

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The role of professional supervision for palliative care doctors in New Zealand: a quantitative survey of attitudes and experiences

Debbie Barham, Wayne de Beer, Helen Clark

Professional supervision may be defined as a collaborative relationship that promotes reflection on contextualised work-related issues for the benefit of ongoing learning and development and improved professional practice. A survey exploring attitudes to and experiences of professional supervision was conducted among doctors working in palliative care in New Zealand. Our survey results showed professional supervision was felt to be important both personally and professionally for enhancing clinical functioning and supporting doctors well-being, and palliative medicine doctors may be in a position to highlight these benefits for the wider medical community.

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A six-year review of patients admitted to hospital with injuries related to quad bike use

Janet Amey, Grant Christey

Despite continued public debate and education on the safe use of quad bikes, injuries severe enough to require hospitalisation continue to occur. Children continue to be injured, both as riders and passengers. Ageing farmers are a developing area for concern. While workplace safety garners most of the safety attention, two other areas also deserve injury prevention consideration; injuries that occur on-farm but not during farming activities and those occurring off-farm to recreational riders.

Viewpoint

SUMMARY

Influences and policies that affect immunisation coverage—a summary review of literature

Mary Nowlan, Esther Willing, Nikki Turner

Almost everyone needs to be immunised for vaccines to work well and to prevent diseases from spreading. Parents are more likely to trust and accept vaccines when they can discuss their concerns early during pregnancy with a health professional. Good experiences, such as less pain and stress during vaccinations, help to maintain positive attitudes towards vaccines and healthcare throughout life. Compulsory vaccination can increase mistrust and penalise those already experiencing hardship and loss of trust. Positive recommendations and well-designed immunisation programmes can help to reach high-level immunisation coverage without mandates.

Article

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Faecal biomarkers do not always identify pre-cancerous lesions in patients who present in primary care with bowel symptoms

Jacqueline Keenan, Alan Aitchison, Jacquie Leaman, John Pearson, Frank Frizelle

Bowel cancer is often asymptomatic in the early stages, meaning that many people present with advanced disease with resulting increased morbidity and mortality. When bowel cancer, however, is diagnosed at an early stage, it has a good prognosis, hence the desire to identify it early or better, before polyps become cancerous. The gold standard for early detection of pre-cancerous changes in the bowel is colonoscopy, where the polyps, the potential precursors of cancer, can be detected and removed. Colonoscopy, however, is not used as a population screening tool due to cost (risk)-benefit. Instead, doctors currently rely on the detection of faecal occult blood (FOB) in stool samples. This test is, however, not that sensitive or specific. This study looked at a new alterative biomarker; a tumour-derived protein marker (M2-PK). The study found that though this test (M2-Pk) was better than looking for occult blood in the stool, it also lacks the diagnostic accuracy to identify individuals who should be progressed for clinical follow-up.

Editorial