Issue

Vol 133 No 1525: 20 November 2020

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Issue Summary

Article

SUMMARY

Point prevalence surveys of antimicrobial use in adult inpatients at Canterbury District Health Board Hospitals

Sharon J Gardiner, Ari B Basevi, Niall L Hamilton, Sarah CL Metcalf, Stephen T Chambers, Stephen G Withington, Paul K Chin, Joshua T Freeman, Simon C Dalton, on behalf of the Canterbury District Health Board Antimicrobial Stewardship Committee

Inappropriate antimicrobial use causes patient harms through ineffective prevention and treatment of infection, and adverse effects including antimicrobial resistance. Audits of antimicrobial use help inform initiatives to improve antimicrobial prescribing. “Snapshot” audits at three Canterbury DHB facilities showed that around 83% of antimicrobial prescriptions were appropriate, but identified important areas (such as guidelines compliance) for improvement.

Article

SUMMARY

Pregnant women’s knowledge of, and adherence to, New Zealand Food Safety in Pregnancy guidelines

Emma Jeffs, Jonathan Williman, Cheryl Brunton, Joanna Gullam, Tony Walls

Foodborne infections, such as listeria, can have devastating consequences for pregnant women. In the most serious cases, infection can lead intrauterine death or stillbirth. The New Zealand Food Safety in Pregnancy guidelines provide recommendations for safe eating in pregnancy that are designed to reduce the risk of foodborne illnesses. This study identified that the majority of pregnant women continue to consume foods that are considered unsafe during pregnancy. Māori women, in particular, were identified as having lower levels of knowledge and lower adherence to the guidelines. This study highlights the need for comprehensive food safety advice early in pregnancy, and also continued reminders throughout pregnancy. The results also suggest a need for food safety guidance to be made more accessible and relevant to the needs of Māori women.

Article

SUMMARY

Feasibility and outcomes of a hepatitis C screening programme in community pharmacies

Natalie Gauld, John Perry, Catherine Jackson, Ed Gane

More than 200 New Zealanders die or undergo liver transplantation each year for complications of untreated hepatitis, all preventable with earlier diagnosis and treatment. Although PHARMAC-funded antiviral therapy will cure >99% of patients with hepatitis C and can be prescribed in the community, treatment uptake remains low, reflecting lack of awareness and diagnosis. Wider access to diagnosis and treatment is essential if New Zealand is to reach the WHO goal of eliminating hepatitis C by 2030. Community pharmacies could become an important part of our national elimination strategy.

Article

SUMMARY

COVID-19 lockdown impact on common general surgical acute presentations to a regional centre in New Zealand | OPEN ACCESS

Leah Boyle, Alexander Boyle, Sharon Jay, Jacques Marnewick

We looked at the effect of the national COVID-19 lockdown on presentations to hospital with three common surgical diseases. These were appendicitis which is inflammation of the appendix (a small part of the bowel), cholecystitis which is inflammation/infection of the gallbladder (the organ which stores bile from your liver) and diverticulitis which is inflammation/infection of small outpouchings usually from the large bowel. We looked at the treatment people received which included antibiotics and different surgeries: laparoscopic appendectomy (keyhole removal of the appendix), laparoscopic cholecystectomy (keyhole removal of the gallbladder) and diagnostic laparoscopy (using a camera to have a look into the abdomen to help with a diagnosis).

Viewpoint

SUMMARY

The legacy of MeNZB and possible implications for COVID-19 vaccination | OPEN ACCESS

James Stewart Reid

The meningococcal B vaccine, MeNZB, was in routine use in New Zealand from July 2004 until June 2008, to provide protection against the strain of group B Meningococci that had caused a major meningitis epidemic. Three doses were given to over a million individuals, aged six weeks to 20 years, at a cost of more than $200M. The expected legacy of MeNZB is that it contributed to a reduced incidence of meningococcal infections and required the development of the National Immunisation Register. The unexpected legacies are that MeNZB provided some protection against gonococcal infections and it is now a component of a licensed vaccine in regular use in the UK. Given the MeNZB experience, are there any lessons to be learned which may assist in the delivery and safety monitoring of a Covid-19 vaccine?

Article

SUMMARY

Diabetic ketoacidosis admissions at Middlemore Hospital: observational study of cause and patient demographics

Jessica Heejong Lee, Brandon Jon Orr-Walker

Diabetic ketoacidosis (DKA) is a serious complication of type 1 diabetes. This study looked into all DKA admissions to Middlemore Hospital from July 2015 to June 2016, and revealed that those of lower socioeconomic status (quintile 5), and Pasifika and Māori ethnicity made up a greater proportion of the DKA admissions in relation to the regional census data. This raises concerns that these populations maybe at greater risk of developing DKA.

Article

SUMMARY

Ethnic inequities in screening for diabetes in pregnancy in New Zealand—adherence to national guidelines | OPEN ACCESS

Lynne Chepulis, Ryan Paul, Elizabeth Lewis-Hills, Manjula Ratnaweera, Neve Mclean, Louise Wolmarans, Jade Tamatea

Screening for diabetes is important to improve the outcomes of any women and babies that are affected. Overall, screening for gestational diabetes (diabetes arising during pregnancy) was low, though the screening rate in Māori women was only half that of non-Māori women (17.5% vs 31.6%).

Article

SUMMARY

Point-of-care rapid testing for hepatitis C antibodies at New Zealand needle exchanges

Geoff Noller, Jenny Bourke

People who inject drugs (PWID) are the population most at risk of exposure to hepatitis C (HCV). This paper describes a pilot project that aimed to have non-clinical peer staff at needle exchanges provide HCV rapid antibody testing to needle exchange clients. This is called ‘point-of-care-testing’ (POCT). These antibody tests, or POCTs, show if a person has been exposed to HCV at some point (eg, if they have HCV antibodies), although they don’t show if a person is currently infectious. They are called rapid tests because the test result is available 5–15 minutes. By using a low-cost test and peer staff who are trusted by clients, the Needle Exchange Programme can cost-effectively access exposed clients, whose blood status can then be confirmed by further testing. If they are found to be currently infected, clients can then be supported into treatment with the new generation of anti-HCV drugs. Successfully treating this vulnerable population is crucial if New Zealand wants to reach its target of eliminating HCV by 2030.

Article

SUMMARY

Successful use of generic direct acting antiviral medications to treat hepatitis C—a New Zealand-wide study

Kristina Aluzaite, Margaret Fraser, Steve Johnson, Hannah Giles, Michael Schultz

Each year, over 399,000 deaths worldwide are attributable to hepatitis C-related liver disease, mostly due to complications related to liver cirrhosis or hepatocellular carcinoma. This could mostly be avoided through the use of new generation of hepatitis C (HCV) medications with reported cure rates above 95%. However, these are often inaccessible due to the high cost of branded medications. We studied the use of generic direct acting antiviral medications to treat HCV medications and found 95.1% (154/162) of those treated were cured from HCV. The study participants also had minimal side effects, making it a safe, efficient and cheaper than branded medications option.

Article

SUMMARY

An audit of fluid resuscitation practice in trauma patients with major haemorrhage at Christchurch Hospital

Calan Jones, Bianca Wadham, Wayne Morriss, Andrew McCombie, Melissa Evans, Christopher Wakeman

Research has shown that patients with severe bleeding following trauma have better outcomes if fluids are used judiciously and blood products are transfused in predetermined ratios. An audit at Christchurch Hospital has shown that although clinical practice has improved with less fluids being administered over the first 24 hours of care and blood products being administered in ratios closer to the guidelines, there is still room for improvement. Trauma patients are cared for by multiple different specialties and in order to continue to improve clinical practice, education will need to involve all members of the trauma team.

Article

SUMMARY

Characteristics, trends and outcomes in acute coronary syndromes in the renal replacement therapy population: a 10-year retrospective analysis of the Midlands Region, New Zealand

Lance Ng, Tze Vun Liew, Andrew Henderson

A study was conducted in the Midlands Region of New Zealand looking at heart attacks occurring in the dialysis patients over the last 10 years. The investigators found that Māori were heavily over-represented in the cohort, compared to national averages in the dialysis and heart attack databases. Additionally, the study showed that almost half the dialysis patients who did have heart attacks did not survive beyond a year after that event. In short, the study serves as a strong reminder that there is still much to do to improve the outcomes in this vulnerable population of patients.

Editorial