Issue

Vol 133 No 1522: 25 September 2020

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Issue Summary

Viewpoint

SUMMARY

New Zealand doctors and euthanasia—legal and practical considerations of the End of Life Choice Act | OPEN ACCESS

Bruce CH Tsai, David B Menkes

New Zealanders will be voting on the End of Life Choice Act in the upcoming referendum in October. This paper examines what this would mean for doctors, patients and families based on experience in countries where euthanasia is already legal. By putting the New Zealand Act in context and comparing it with legal frameworks overseas, we identify what doctors and others need to know. We also highlight issues that still need to be worked through and clarified to ensure that end-of-life choices are informed, settled and free from coercion, and provide examples that may assist determination of this.

Article

SUMMARY

Lessons from a system-wide response to a measles outbreak, Canterbury, February–April 2019

Daniel Williams, Meik Dilcher, Hongfang Dong, Bridget Lester, Kerry Marshall, Ramon Pink, Debbie Smith, Jimmy Wong

New Zealand is at ongoing risk of measles outbreaks, due to sub-optimal vaccination coverage. Canterbury experienced a measles outbreak from February to April 2019. Canterbury’s whole-of-health-system response helped contain the outbreak to 38 cases. A systematic primary care-based measles vaccination catch-up campaign could prevent future measles outbreaks.

Article

SUMMARY

Why dizziness is likely to increase the risk of cognitive dysfunction and dementia in elderly adults

Paul F Smith

Dizziness related to inner ear dysfunction of the balance organs (the ‘vestibular system’) causes memory impairment, independently of hearing loss, by disrupting the function of neurons in brain regions responsible for remembering places in the environment. It is therefore possible that dizziness related to vestibular dysfunction increases the risk of dementia, including Alzheimer’s disease. Vestibular rehabilitation, a non-invasive form of exercise, may reduce the risk of dementia.

Article

SUMMARY

How is dementia portrayed in New Zealand newsprint media? Causes, effects and moral evaluation

Sarah Cullum, Rachael Simpson, Farzana Gounder

Dementia in New Zealand is expected to triple in the next 30 years at which point 170,000 people and their families will be affected. The media play an important role in not only disseminating information to the public but also shaping opinions and behaviours towards families living with dementia. We examined New Zealand’s three largest daily newspapers and found that dementia is still largely portrayed from a victimhood viewpoint. Up to 40% of dementia is potentially preventable and positive media representation could empower the public regarding attitudes towards dementia.

Article

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Knowledge and perspectives about the use of cannabis as a medicine: a mixed methods observational study in a cohort of New Zealand general practice patients

Karen Oldfield, Allie Eathorne, Ingrid Maijers, Richard Beasley, Alex Semprini, Irene Braithwaite

This study explored what a group of GP patients knew and had experienced regarding the use of cannabis as a medicine. The majority of patients reported being comfortable discussing medicinal cannabis use with their doctors and were willing to use prescribed medicinal cannabis products. When considering their own medical conditions, just under half thought that medicinal cannabis may be helpful; primarily for pain relief. Few patients had talked to their doctors regarding medicinal cannabis use. Patients have expressed that they would like information about medicinal cannabis from their doctors that is in keeping with what would be conveyed regarding regular prescribed medications.

Viewpoint

SUMMARY

Computers, confounding, clusters, consent, cost, COVID and consultation: how the Health and Disability Code impedes the learning health system | OPEN ACCESS

Mark Webster, Ralph Stewart

The Health and Disability Code, resulting from the Cartwright Inquiry and protecting patient rights, precludes any research without participant consent. Comparative effectiveness studies—a cornerstone of the learning health system—compare well-established drugs/procedures/practices used for the same condition. Randomisation is the only way to ensure that the comparison is reliable. Some comparative effectiveness studies cannot practicably be undertaken with participant consent. The Code needs carefully considered updating, to improve patient heathcare delivery.

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SUMMARY

The assessment of testamentary capacity

Jane Casey, Anthony Grant

People are living longer with chronic medical conditions including cognitive impairment and with increased wealth. Recent New Zealand Court decisions will likely result in more demand for contemporaneous medical assessments of the capacity to make a will. This paper outlines the clinical assessment and the legal test. Careful assessments could protect the older adult and minimise the risk of a contested will after death.

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SUMMARY

A model respiratory personal protective programme for the New Zealand healthcare industry | OPEN ACCESS

Chris Walls, Geraint Emrys, Siobhan Gavaghan, Des Gorman, David McBride, Dave McLean

In the absence of advice from the workplace regulator these Doctors with workplace experience in healthcare offer a model respiratory protection programme for healthcare institutions to consider and adapt to their requirements.

Viewpoint

SUMMARY

Management of personal protective equipment in New Zealand during the COVID-19 pandemic: report from the Auditor-General | OPEN ACCESS

Elizabeth Fenton

In June 2020 the Office of the Auditor-General released its report on the management of personal protective equipment (PPE) in New Zealand during the COVID-19 pandemic. This viewpoint article addresses three issues of ethical concern raised in the report: inadequate stock, inequity and complacency. It highlights the importance of healthcare worker trust in the institutions they work for, and investment in a robust public health system. Acting on the report’s recommendations is a critical step in strengthening New Zealand’s preparedness for future public health crises.

Article

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Patient characteristics and predictors of completion of a pulmonary rehabilitation programme in Auckland, New Zealand

Sarah Candy, Nicola Jepsen, Christin Coomarasamy, Jonathan Curry, Grace Dodson, Joe Pomelile, Mitchel Versey, Julie Reeve

Pulmonary rehabilitation (PR) for people living with a long-term respiratory illness is an effective intervention which can reduce symptoms and improve health-related quality of life. Despite the compelling evidence for this intervention, attendance and completion of PR worldwide is low. Our study identified predictors to completion of a PR programme in Counties Manukau, New Zealand. Being of an older age group, having a higher exercise capacity and of European ethnicity was found to be independent predictor of completion in this cohort. Future service improvements in the provision and delivery of PR programmes in New Zealand need to ensure we are providing accessible options for younger participants, supporting those with lower exercise tolerance and ensure services are engaging for all ethnicities.

Article

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A feasibility study investigating the impact of a dietitian-led low in fermentable oligosaccharide, disaccharide, monosaccharide and polyols diet group education programme with irritable bowel syndrome

Dorcas Chan, Paula Skidmore, Leigh O’Brien, Sally Watson, Richard Gearry

Many people have irritable bowel syndrome (abdominal pain with diarrhoea, constipation). Treatments are limited but a special diet called low FODMAP diet can help. Usually a dietitian needs to teach this one on one with the patient, but this study has shown that it is feasible to teach this in a group setting.

Viewpoint

SUMMARY

A pragmatic diagnostic approach to myocardial infarction with non-obstructive coronary arteries

Ammar J Alsamarrai, Jocelyne R Benatar, Eun Soo Chung, Jithendra B Somaratne

A heart attack is usually caused by a blockage in the arteries that supply the heart. However, some people who suffer a heart attack have rather normal looking heart arteries. In these cases, it can be difficult to figure out what caused the heart attack. We propose a simplified algorithm (originally designed by the American Heart Association) to help heart specialists decide which tests to do in patients with heart attacks and normal looking heart arteries.

Article

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Medication dispensing for attention-deficit/hyperactivity disorder to New Zealand youth

Stephanie D’Souza, Nicholas Bowden, Sheree Gibb, Nichola Shackleton, Richard Audas, Sarah Hetrick, Barry Taylor, Barry Milne

Over a 10-year period, medication dispensing prevalence for attention-deficit/hyperactivity disorder (ADHD) almost doubled in young New Zealanders aged 1–24 years. Medication was more common in males and in those between 7–17 years old. Strong socioeconomic differences in medication were not apparent when looking at the youth population as a whole but were more noticeable within specific ethnic groups, with different patterns observed across ethnic groups. Dispensing prevalence increased as area deprivation level increased in Europeans only, but the opposite trend was generally apparent in Pasifika youth. These results suggest that healthcare disparities may exist within certain ethnic groups.

Article

SUMMARY

Hui: a partnership in practice in familial hypercholesterolemia

Jocelyne Benatar, Tara Elville, Helen Wihongi, The Whānau

Genetic mutations causing very high cholesterol levels that lead to premature heart disease is the most common genetic disorder and occurs in 1 in 250 people. The incidence in Māori is not known and New Zealand has no systematic way of screening and managing these patients. This paper describes a large whanau who have endured many tangihanga as a result of premature heart disease caused by a gene mutation. It describes establishing a partnership with whanau so they hold all the information on this disorder to empower all members, ensuring appropriate screening and treatment no matter where they live.

Article

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Are over-the-counter fish oil supplements safe, effective and accurate with labelling? Analysis of 10 New Zealand fish oil supplements

Julia J Rucklidge, Ian C Shaw

The study shows that 90% of the most popular fish oil supplements sold in New Zealand are true to label based on the stated capsule omega fatty acid content. All of the products studied indicated benefits across heart, brain and joint health. Based on studies published in scientific journals, 30% of the products would result in benefits across heart, brain and joint health when taken at the top dose recommended on the label. Mercury was not found in any of the samples analysed; therefore, even if some of the products might not confer health benefits at the recommended doses, they are all safe to consume.

Editorial