Vol 133 No 1523: 9 October 2020

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Issue Summary

Article

SUMMARY

Turning on a dime—pre- and post-COVID-19 consultation patterns in an urban general practice | OPEN ACCESS

Carol Atmore, Tim Stokes

In this study we looked at how patients consulted with their general practice in one city-based general practice during the first two weeks of Level 4 COVID-19 lockdown, and compared it to the same fortnight period of the previous year. While similar numbers of patients consulted with the practice in both years, there was a large difference in how patients consulted with their general practice. During the COVID-19 lockdown, eight in 10 patient contacts where done via telephone, whereas in 2019 only three in 10 contacts were by phone, with the rest being in-person at the practice. Most acute illnesses, accident-related and long-term health condition-related consultations were able to be provided by phone, but most prevention-related consultations, such as immunisations, needed to be face-to-face. Repeating this study and involving more practices would be useful to track these trends as COVID-19 continues and beyond.

Article

SUMMARY

New Zealand may finally get funded access to diabetes drugs which reduce cardiovascular events and progression of kidney disease: an audit of proposed PHARMAC criteria compared with international guidelines | OPEN ACCESS

Moritz Vitz, Bridget Moss, Hannah Ward, Poonam Soma, Jacob Isichei-Kizito, Rosemary Hall, Jeremy Krebs

Two new classes of medication for the management of type 2 diabetes, the Sodium-Glucose Cotransporter-2 (SGLT-2) inhibitors and Glucagon-like Peptide-1 (GLP-1) Agonists are medications shown to reduce cardiovascular events and slow decline in kidney function in people with type 2 diabetes. They are recommended for many people as the next medications after metformin by the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD). PHARMAC have proposed criteria for funding in New Zealand. This clinical audit compares which patients would be eligible for treatment under each criterion. Under PHARMAC criteria 34.4% patients would be eligible for funded access compared with 27.2% by the 2018 ADA/EASD criteria and 48.2% by the revised 2020 ADA/EASD criteria. The proposed PHARMAC criteria will give access to these important drugs to those people with type 2 diabetes who will likely benefit the most.

Article

SUMMARY

A three-way comparison of glycated haemoglobin: are results from the three platforms interchangeable?

Samarina MA Musaad, George Chan, Campbell Kyle

Genetic variants in haemoglobin are becoming more common in New Zealand as the population becomes more ethnically diverse. Such variants can potentially affect the analysis and interpretation of glycated haemoglobin (HbA1c), a key test in the diagnosis and monitoring of diabetes, when different laboratory methods are used. We therefore studied the comparability of laboratory results using three different methods in a sample of patients with one or more haemoglobin genetic variants. Our analysis showed that the three methods studied gave very similar results in this group, facilitating commutability of results between New Zealand laboratories when managing patients.

Article

SUMMARY

A survey of the NP workforce in primary healthcare settings in New Zealand

The survey described the demographics, distribution, clinical settings, and employment arrangements of the nurse practitioner workforce in primary healthcare settings. It was completed by 160 nurse practitioners (of an estimated 224). Nurse practitioners are expert nurses with advanced education and clinical training authorised to assess, diagnose and prescribe medications, in a similar way as general practitioners. The results showed that the nurse practitioner workforce offers stability and flexibility across multiple clinical settings in primary healthcare and provides a potential solution to the general practitioner workforce shortage.

Article

SUMMARY

Associations between childhood cancer treatment and tooth agenesis

Matthew Shum, Erin Mahoney, Kate Naysmith, Yaso Ramadas, Manisha Narsinh, Heather Anderson, Arun Natarajan, Elizabeth Hitchings, Rob Corbett, Scott Macfarlane

Children in New Zealand who undergo treatment for cancer (which may include chemotherapy, head and neck radiation therapy (HNRT), and stem cell therapy (SCT)) experience more dental agenesis (missing teeth), microdontia (small teeth) and root abnormalities than those in the general population. Certain chemotherapy drugs, HNRT and SCT were correlated with more missing teeth. In New Zealand, all children are provided with funded dental treatment including restorations and preventive treatment up until the age of 18 years. However, the lack of funding for oral rehabilitation including complex restorative, orthodontic treatment and oral surgery could result in a significant financial burden for long-term childhood cancer survivors and their families. Therefore, inequitable access to oral rehabilitation for this patient group argues for a mechanism for consistent improved access to publicly funded dental care across district health boards in New Zealand.

Article

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Sexual assault experiences of university students and disclosure to health professionals and others

Melanie A Beres, Zoran Stojanov, Katie Graham, Gareth J Treharne

A new study has investigated student experiences of sexual assault at a New Zealand university and found few survivors disclose their experience to health professionals or support services. The study involved a sample of 1,540 students, who completed an online survey about their experiences, and whether they had reported it to a health professional or support service. The study found 28% of survey respondents, or 431 students mostly between 18–23 years old, recorded experiencing some form of sexual assault in their time as a student. Across 556 distinct incidents, 178 had told no one about the specific incident, while 179 had told one supporter and 42 (7.6%) had told a health professional. The results are consistent with international research on sexual assault on university campuses.

Article

SUMMARY

Prostate cancer screening in New Zealand: lessons from the past to shape the future in the light of changing evidence

Bashar Matti, Kamran Zargar-Shoshtari

Routine screening or testing for prostate cancer in all men is currently not recommended in New Zealand. In this paper, we reviewed the relevant local and international data on this topic. We found that current approach to prostate cancer screening is largely outdated and associated with significant ethnic and socioeconomic disparities. Therefore, we urge the policy makers to re-evaluate this aspect and assure that every Kiwi man has the best possible understanding and access to prostate cancer screening in the future.

Viewpoint

SUMMARY

The clinical toxicology of cannabis | OPEN ACCESS

Leo J Schep, Robin J Slaughter, Paul Glue, Paul Gee

Use of cannabis (taken either orally or by inhalation) can lead to sedation, euphoria and relaxation. Adverse effects may include unease, hallucinations and the loss of full control of bodily movements (thereby increasing the risk of motor vehicle accidents) and, notably in children, coma and seizures. Long-term use has been associated with a range of psychiatric conditions. THC, the principal psychoactive component of cannabis, only remains in the blood for hours after use before the metabolised product partitions into the fat, from where it leaches out and can be detected in urine for weeks after use; this forms the basis for workplace drug testing. Treatment for acute intoxication mainly consists of appropriate supportive care, though children are more susceptible and therefore may require additional medical treatment for severe symptoms.

Editorial