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Issue

Vol 133 No 1518: 17 July 2020

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Issue Summary

Article
SUMMARY

A detailed analysis of quality improvement and patient safety within undergraduate health professional curricula in Aotearoa New Zealand

Susan Shaw, Karina Donaldson

The education of health professionals requires attention to a wide range of skills and knowledge. It is a priority to ensure that quality and safety are included in curricula. A previous study (Robb et al, 2017) asked educators key questions about quality improvement and patient safety. This paper extends that work by presenting analyses of curricula across a wide range of professional education programmes in Aotearoa New Zealand. It found relevant concepts are addressed within curricula and suggested an extended set of terms for identifying and describing them.

Article
SUMMARY

Hazardous drinking and general practitioner visits in the past year

Angela Jury, Ashley Koning, Jennifer Lai, Charito Tuason, Terry Huriwai, Sarah Hetrick

Māori and non-Māori under 45 who are risky drinkers have different patterns of general practitioner (GP) visits. While young non-Māori are more likely to visit a GP if they drink hazardously, providing an opportunity for screening, access to GPs is similar for Māori regardless of their drinking behaviour. Young Māori males are the least likely to visit a GP overall, highlighting the need to prioritise strategies that improve equity in service access.

Viewpoint
SUMMARY

Erionite in Auckland bedrock and malignant mesothelioma: an emerging public and occupational health hazard? | OPEN ACCESS

Martin S Brook, Philippa M Black, Jennifer Salmond, Kim N Dirks, Terri-Ann Berry, Gregor Steinhorn

Erionite, a rock mineral known to cause a type of lung cancer known as malignant mesothelioma (MM) has been found in rocks within the Auckland region. Erionite becomes hazardous when natural processes or human activities result in small particles of erionite dust getting into the air. Recent advances in international literature highlight the potential risk of occupational and public exposure to erionite from construction activities. New Zealand has elevated rates of MM yet the effect of erionite exposure, potentially from dust created during earthworks, is unknown.

Article
SUMMARY

VOICES: South Island pilot survey of bereaved people

Kate Reid, Ray Kirk, Pauline Barnett, Ann Richardson, Annabel Ahuriri-Driscoll

The VOICES survey, modified for the New Zealand context, is an acceptable tool for bereaved relatives to voice their thoughts on end of life care for their loved one. Further modifications to the survey would be useful before a national survey is considered. The data and comments offered by bereaved relatives is helpful to policy makers and health practitioners across healthcare settings to support and improve end-of-life-care. The vast majority of relatives acknowledged their loved on was treated with respect and dignity across all settings and there was good communication. Most people wish to die at home but very few manage to do so, improved coordinated community services would assist but relatives felt their family member died in the right place.

Article
SUMMARY

Severe early childhood caries: a modern (neglected) epidemic?

Philip J Schluter, Jesse Kokaua, Martin Lee

A recent series in the Lancet argued that oral health carries a large societal burden and radical action is needed. Part of this radical action is a re-thinking of the primary healthcare importance and integration of oral health service delivery. Fundamental to this is understanding the epidemiology and promoting evidence-based preventive strategies. This paper is deliberately designed and written for the New Zealand Medical Journal to bring Canterbury children’s oral health to the forefront of a wider New Zealand readership, demonstrate the current considerable inequalities, and urge us to rethink the status quo both locally and nationally. Looking at the most recent available data, we observed that: 1) Severe early childhood caries rates in Canterbury’s is high—at nearly one in five children. 2) Rates in our Pacific children (40.1%) and Māori children (26.2%) are sadly much higher—and likely reflect social determinants of health inequities (such as poverty) between children rather than intrinsic cultural differences. 3) One in 20 of these children also required teeth extraction(s). 4) These come at considerable individual and societal costs, and have long-term consequences. 5) Despite the best efforts of many over a long period of time, too many children continue to suffer from a heavy oral health burden. If we wish to valve our children’s oral health, then radical action is indeed required.

Article
SUMMARY

Reduced community antibiotic dispensing in New Zealand during 2015–2018: marked variation in relation to primary health organisation

Mark Thomas, Andrew Tomlin, Eamon Duffy, Murray Tilyard

We studied the amount of antibiotics dispensed by community pharmacies in New Zealand. The total amount of antibiotics dispensed by community pharmacies in New Zealand decreased each year between 2015 and 2018. While community antibiotic dispensing decreased in all district health boards (DHBs) and in all primary health organisations (PHOs) there were marked differences between the 20 DHBs, and between the 35 PHOs, in the size of the annual reductions in antibiotic dispensing. We recommend a further 25% reduction in total community antibiotic dispensing for non-Māori and non-Pacific people, but a 2% increase in total community antibiotic dispensing for Māori and Pacific people. Unnecessary antibiotic prescribing should be reduced in all population groups, but there is also a need for increased appropriate antibiotic prescribing for Māori and Pacific people.

Article
SUMMARY

Lipid monitoring in a community cohort of people taking statins: who is tested and is testing associated with subsequent alteration in therapy?

Harrison Beadel, Andrew Halim, Paul Bridgford, Ben Hudson

Statins are widely used and current clinical guidance suggests regular (typically annual) cholesterol testing in patients receiving these medicines. We found that about half of patients in our cohort had been tested within this timeframe. Interestingly, there was only a small difference in the likelihood of a change in treatment between those who were tested and those who weren’t (23% vs 19%). There is little evidence to guide optimal testing for patients taking statins—it may be that annual testing is too frequent. We call for a stronger evidence base to inform us of the best approach to monitoring this large group of patients.

ALL ARTICLES
SUMMARY
Editorial
Vol 133 No 1518: 17 July 2020

Invest in prevention to improve child oral health in the long-term

Jonathan M Broadbent

In this issue of the New Zealand Medical Journal, Schluter, Kokaua and Lee characterise the prevalence of severe early childhood (S-ECC) caries among five-year-olds seen in Canterbury District Health Board’s Community Oral Health Service as an epidemic.

Article
Vol 133 No 1518: 17 July 2020

A detailed analysis of quality improvement and patient safety within undergraduate health professional curricula in Aotearoa New Zealand

Susan Shaw, Karina Donaldson

Improvement science is an acknowledged field of expertise which is rightfully used in analysing healthcare practice and therefore an appropriate context from which to interrogate the education of health professionals. The World Health Organization has published guidance on patient safety in health professional curricula.

Article
Vol 133 No 1518: 17 July 2020

Hazardous drinking and general practitioner visits in the past year

Angela Jury, Ashley Koning, Jennifer Lai, Charito Tuason, Terry Huriwai, Sarah Hetrick

Alcohol use is a risk factor for both mental and physical health problems, and is associated with an increased risk of suicide and premature mortality.

Article
Vol 133 No 1518: 17 July 2020

VOICES: South Island pilot survey of bereaved people

Kate Reid, Ray Kirk, Pauline Barnett, Ann Richardson, Annabel Ahuriri-Driscoll

From 2016–2038, the number of people dying in New Zealand is predicted to increase by almost 50%. These projections indicate that palliative care requirements will increase by 37.5% in public hospitals, 84.2% in aged residential care (ARC) and 51.8% in hospice care.

Article
Vol 133 No 1518: 17 July 2020

Severe early childhood caries: a modern (neglected) epidemic?

Philip J Schluter, Jesse Kokaua, Martin Lee

“Baby teeth do not matter as they fall out anyway” and “all children eventually get holes in their teeth” are but two common perceptions in New Zealand.

Article
Vol 133 No 1518: 17 July 2020

Reduced community antibiotic dispensing in New Zealand during 2015–2018: marked variation in relation to primary health organisation

Mark Thomas, Andrew Tomlin, Eamon Duffy, Murray Tilyard

Concern about the rising prevalence of resistance to antibiotics in a wide range of bacteria has stimulated efforts in many countries to reduce inappropriate antibiotic use.

Article
Vol 133 No 1518: 17 July 2020

Lipid monitoring in a community cohort of people taking statins: who is tested and is testing associated with subsequent alteration in therapy?

Harrison Beadel, Andrew Halim, Paul Bridgford, Ben Hudson

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality, and CVD risk assessment and management have become routine primary care activities.

Viewpoint
Vol 133 No 1518: 17 July 2020

Erionite in Auckland bedrock and malignant mesothelioma: an emerging public and occupational health hazard? | OPEN ACCESS

Martin S Brook, Philippa M Black, Jennifer Salmond, Kim N Dirks, Terri-Ann Berry, Gregor Steinhorn

Asbestos-induced malignant mesothelioma (MM) is of worldwide concern but particularly in New Zealand. The highest mesothelioma incidence is in the construction and building trades.

Clinical Correspondence
Vol 133 No 1518: 17 July 2020

Opioid dependence with successful transition to suboxone (buprenorphine/naloxone) in a young woman with hereditary coproporphyria

Cindy Towns, Holly Mee, Sam McBride

We present a patient with hereditary coproporphyria (HCP) whom developed opioid dependence and was successfully transitioned from high dose fentanyl to suboxone (buprenorphine/naloxone). This is the first documented use of suboxone in the acute porphyrias.

Clinical Correspondence
Vol 133 No 1518: 17 July 2020

A swinging heart in cardiac tamponade

Allan Plant, Stuart Tie

A 47-year-old woman with a history of metastatic breast cancer and paroxysmal atrial fibrillation presented with four days of shortness of breath associated with orthopnea.

Letter
Vol 133 No 1518: 17 July 2020

Perry syndrome: a case of atypical parkinsonism with confirmed DCTN1 mutation: a response

Pawel Tacik, Zbigniew K Wszolek

With great interest, we have read the article entitled “Perry syndrome: a case of atypical parkinsonism with confirmed DCTN1 mutation“ by McManus et al published in 24 April edition of the New Zealand Medical Journal.

Obituary
Vol 133 No 1518: 17 July 2020

Rexley Blake Hunton

Felicity Goodyear-Smith

Rex was born in 1932 in Papatoetoe, Auckland. His parents had a poultry farm in Papatoetoe but had to walk away from it in the Great Depression and start again.

100 Years Ago in the NZMJ
Vol 133 No 1518: 17 July 2020

Spinal Anaesthesia

By ALFRED C. SANDSTON, M.D., F.R.C.S.E.

I may be excused for the comparative scrappiness of this paper when I state that I have had only six days’ notice for its preparation; but the subject is an interesting and important one, and these notes may be provocative of discussion both interesting and informing and help to spread some knowledge.

Proceedings
Vol 133 No 1518: 17 July 2020

Abstracts for the 249th Otago Medical School Research Society Research Staff Speaker Awards

Proceedings
Vol 133 No 1518: 17 July 2020

Abstracts for the 248th Otago Medical School Research Society Summer Student Speaker Awards

Article
SUMMARY

A detailed analysis of quality improvement and patient safety within undergraduate health professional curricula in Aotearoa New Zealand

Susan Shaw, Karina Donaldson

The education of health professionals requires attention to a wide range of skills and knowledge. It is a priority to ensure that quality and safety are included in curricula. A previous study (Robb et al, 2017) asked educators key questions about quality improvement and patient safety. This paper extends that work by presenting analyses of curricula across a wide range of professional education programmes in Aotearoa New Zealand. It found relevant concepts are addressed within curricula and suggested an extended set of terms for identifying and describing them.

Article
SUMMARY

Hazardous drinking and general practitioner visits in the past year

Angela Jury, Ashley Koning, Jennifer Lai, Charito Tuason, Terry Huriwai, Sarah Hetrick

Māori and non-Māori under 45 who are risky drinkers have different patterns of general practitioner (GP) visits. While young non-Māori are more likely to visit a GP if they drink hazardously, providing an opportunity for screening, access to GPs is similar for Māori regardless of their drinking behaviour. Young Māori males are the least likely to visit a GP overall, highlighting the need to prioritise strategies that improve equity in service access.

Article
SUMMARY

VOICES: South Island pilot survey of bereaved people

Kate Reid, Ray Kirk, Pauline Barnett, Ann Richardson, Annabel Ahuriri-Driscoll

The VOICES survey, modified for the New Zealand context, is an acceptable tool for bereaved relatives to voice their thoughts on end of life care for their loved one. Further modifications to the survey would be useful before a national survey is considered. The data and comments offered by bereaved relatives is helpful to policy makers and health practitioners across healthcare settings to support and improve end-of-life-care. The vast majority of relatives acknowledged their loved on was treated with respect and dignity across all settings and there was good communication. Most people wish to die at home but very few manage to do so, improved coordinated community services would assist but relatives felt their family member died in the right place.

Article
SUMMARY

Severe early childhood caries: a modern (neglected) epidemic?

Philip J Schluter, Jesse Kokaua, Martin Lee

A recent series in the Lancet argued that oral health carries a large societal burden and radical action is needed. Part of this radical action is a re-thinking of the primary healthcare importance and integration of oral health service delivery. Fundamental to this is understanding the epidemiology and promoting evidence-based preventive strategies. This paper is deliberately designed and written for the New Zealand Medical Journal to bring Canterbury children’s oral health to the forefront of a wider New Zealand readership, demonstrate the current considerable inequalities, and urge us to rethink the status quo both locally and nationally. Looking at the most recent available data, we observed that: 1) Severe early childhood caries rates in Canterbury’s is high—at nearly one in five children. 2) Rates in our Pacific children (40.1%) and Māori children (26.2%) are sadly much higher—and likely reflect social determinants of health inequities (such as poverty) between children rather than intrinsic cultural differences. 3) One in 20 of these children also required teeth extraction(s). 4) These come at considerable individual and societal costs, and have long-term consequences. 5) Despite the best efforts of many over a long period of time, too many children continue to suffer from a heavy oral health burden. If we wish to valve our children’s oral health, then radical action is indeed required.

Article
SUMMARY

Reduced community antibiotic dispensing in New Zealand during 2015–2018: marked variation in relation to primary health organisation

Mark Thomas, Andrew Tomlin, Eamon Duffy, Murray Tilyard

We studied the amount of antibiotics dispensed by community pharmacies in New Zealand. The total amount of antibiotics dispensed by community pharmacies in New Zealand decreased each year between 2015 and 2018. While community antibiotic dispensing decreased in all district health boards (DHBs) and in all primary health organisations (PHOs) there were marked differences between the 20 DHBs, and between the 35 PHOs, in the size of the annual reductions in antibiotic dispensing. We recommend a further 25% reduction in total community antibiotic dispensing for non-Māori and non-Pacific people, but a 2% increase in total community antibiotic dispensing for Māori and Pacific people. Unnecessary antibiotic prescribing should be reduced in all population groups, but there is also a need for increased appropriate antibiotic prescribing for Māori and Pacific people.

Article
SUMMARY

Lipid monitoring in a community cohort of people taking statins: who is tested and is testing associated with subsequent alteration in therapy?

Harrison Beadel, Andrew Halim, Paul Bridgford, Ben Hudson

Statins are widely used and current clinical guidance suggests regular (typically annual) cholesterol testing in patients receiving these medicines. We found that about half of patients in our cohort had been tested within this timeframe. Interestingly, there was only a small difference in the likelihood of a change in treatment between those who were tested and those who weren’t (23% vs 19%). There is little evidence to guide optimal testing for patients taking statins—it may be that annual testing is too frequent. We call for a stronger evidence base to inform us of the best approach to monitoring this large group of patients.

Viewpoint
SUMMARY

Erionite in Auckland bedrock and malignant mesothelioma: an emerging public and occupational health hazard? | OPEN ACCESS

Martin S Brook, Philippa M Black, Jennifer Salmond, Kim N Dirks, Terri-Ann Berry, Gregor Steinhorn

Erionite, a rock mineral known to cause a type of lung cancer known as malignant mesothelioma (MM) has been found in rocks within the Auckland region. Erionite becomes hazardous when natural processes or human activities result in small particles of erionite dust getting into the air. Recent advances in international literature highlight the potential risk of occupational and public exposure to erionite from construction activities. New Zealand has elevated rates of MM yet the effect of erionite exposure, potentially from dust created during earthworks, is unknown.

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