Vol 134 No 1528: 15 January 2021

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Issue Summary

Article

SUMMARY

Counting the cost of major infection and sepsis in New Zealand: an exploratory study using the National Minimum Data Set

Paul J Huggan, Tania A Helms, Veronique Gibbons, Katie Reid, Harry Hutchins, Ian Sheerin

Infections are a common and growing cause of hospital admission in New Zealand, and a proportion of these admissions are complicated by sepsis. Sepsis (blood poisoning/toto pirau) is what happens when the body’s response to an infection damages its own tissues and organs. Although the exact proportion is unknown, we do know that infections occur more commonly in young children, older adults, people with ‘chronic conditions’ and those who live in areas of economic deprivation. This is the first study in New Zealand to look at the costs of a hospital admission with sepsis. The findings suggest that a quarter of hospital in-patients have an infection that can lead to sepsis. When sepsis develops, it costs $11,000 on average and $13,000 for people who are re-admitted after a sepsis episode, comparable with major trauma.

Article

SUMMARY

Interviews with health professionals about the National Child Protection Alert System

Patrick Kelly, Melissa Adam, Carmen Basu, Miranda Ritchie, Denise Wilson, Fred Seymour

The National Child Protection Alert System functions in every district health board. It helps health providers share information with colleagues across New Zealand about children where there have been serious concerns about possible maltreatment, so those colleagues may be more likely to provide appropriate help and/or recognise recurrent abuse or neglect. This research describes how the National Child Protection Alert System is regarded by a representative sample of health professionals who work within it and make decisions about whether an alert will be placed. Generally, health professionals regard the system positively, but they identify a number of areas where the system could be enhanced to improve access to information and reduce any risk of misuse.

Article

SUMMARY

Clinician knowledge of driving restrictions following a stroke event

Laura Stratton, John Parsons, Shannon Tisbury, Susan Waterworth, Nicola Starkey

A stroke can have a dramatic and lasting impact on someone’s life and how they think, move and interact with their environment. Driving after stroke can be particularly challenging, but it is often seen as vital to successful rehabilitation. Health professionals working in acute and rehabilitation services are often expected to provide information and advice about driving restrictions to people in the early stages following stroke. We surveyed 49 health professionals about their knowledge of New Zealand Transport Agency guidelines for driving after stroke and found that many health professionals have discussions with people about driving restrictions following a TIA or stroke. However, there appears to be limited knowledge of all the restrictions for each condition as they relate to either private or commercial vehicle use. Insufficient training and education for clinicians might explain this gap.

Article

SUMMARY

Prognostic significance of mid-range ejection fraction following acute coronary syndrome (ANZACS-QI 23)

Daniel Chan, Robert N Doughty, Mayanna Lund, Mildred Lee, Katrina Poppe, Andrew J Kerr

Previous studies have shown that patients who have suffered a heart attack and who have reduced heart pump function with an ejection fraction of less than 40% have a high risk of dying. In this study, we followed-up over 6,000 New Zealand patients who had a heart attack in 2015. We found that those with mid-range heart pump function with an ejection fraction of 40–50% had a 1.5-fold higher risk of death compared to those with normal ejection fraction, but they had a lower risk compared to those with reduced ejection fraction. Unlike those with reduced ejection fraction following a heart attack, there are no medications that improve outcomes in patients with mid-range ejection fraction. Hence further study is required to identify medications that can improve outcomes for this group.

Viewpoint

SUMMARY

Increasing access to contraception in New Zealand: assessing the impact of a new funding initiative

Orna McGinn, Vicki Mount, Helen Fulcher

New Zealand has high rates of unplanned pregnancy and abortion. Many barriers exist to women’s ability to access the most effective forms of contraception such as the IUD and implant—LARCs (long-acting reversible contraception). Funding released by the Ministry of Health last year to improve access to LARC contraception has failed to make an impact, with each area of the country configuring services in their own way and applying variable eligibility criteria. Information accessed via Official Information Act requests shows that most district health boards have failed to deliver the contraception services for which they were contracted.

Clinical Correspondence

SUMMARY

Think about cats in acute vision loss

Aaron Yap, Moaz Alshaikhi, Kay Evans

Bartonella henselae is a bacteria that can be transferred from cat to humans through cat bites and scratches to cause systemic illness. In a small proportion of cases, it can cause inflammation of the optic nerve and vision loss. In this paper, we describe two such cases that presented to the Palmerston North Eye Department. Research has shown that cases with severe vision loss respond well to a combination of steroid and antibiotic therapy.

Article

SUMMARY

A retrospective analysis of calls to the New Zealand National Poisons Centre regarding Pacific patients

Eeva-Katri Kumpula, Rosalina Richards, Pauline Norris, Vanda Symon, Adam C Pomerleau

This study aimed to describe contacts to the New Zealand National Poisons Centre (NZNPC) in 2018–2019 relating to Pacific patients. Of all 40,185 patients, Pacific patients comprised 3.4%, non-Pacific 61.9% and people of unknown ethnicities 34.7%. A total of 78.0% of Pacific patients were aged 0–5, 70.4% of exposures were due to child exploratory behaviour, where a child explores their surroundings (eg, putting things in their mouths), and 96.8% occurred in residential settings. Pacific patients were most often exposed to substances commonly found in households. The wellbeing of children and youth is central to the aspirations of Pacific peoples, and the NZNPC service could be a useful resource for families if exposures do occur.

Editorial