Issue

Vol 134 No 1529: 5 February 2021

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Issue Summary

Article

SUMMARY

Anticoagulant-related intracranial haemorrhage: time to anticoagulant reversal improving but still slower than thrombolysis for ischaemic stroke

Holly J Mee, Hugh Carl Hanger, Tim Wilkinson, James Michael Beharry, Teddy Wu

The time taken to reverse anticoagulation (blood thinners) when a patient presents with intracranial haemorrhage (bleeding within the brain) is improving over time at Christchurch Hospital. However, these times are much slower than equivalent thrombolysis (medication given to break down clots acutely) for ischaemic (restricted blood flow) stroke. This study recommends equal priority of treatment for patients presenting with intracranial haemorrhage to those presenting with ischaemic stroke.

Article

SUMMARY

New Zealand’s vocational Rural Hospital Medicine Training Programme: the first ten years

Katharina Blattner, Rory Michael Miller, Rachael Lawrence-Lodge, Garry Nixon, Patrick McHugh, Joel Pirini

This study reports the first-decade outcomes of the Rural Hospital Medicine Training Programme (RHMTP), which was established in 2008 in response to serious rural hospital medical workforce shortages. The study found that, of currently practicing RHMTP graduates, 92% (24/26) are working in rural New Zealand, mostly (22/24) in rural hospitals with the majority of graduates also completing vocational general practice training. This study provides the first real evidence on actual postgraduate practice location (as compared to ‘intent to practice’) for rural career choice for New Zealand medical practitioners and adds to international evidence that dedicated rural postgraduate training is strongly associated with entering rural practice. Although trainees value the RHMTP’s flexibility and breadth of clinical exposure, findings also highlight programme-related factors that are impacting progress through the RHMTP for some trainees. Attention to existing barriers will ensure the RHMTP reaches its potential to benefit all of New Zealand’s rural communities.

Article

SUMMARY

Stereotactic ablative radiotherapy for early stage lung cancer and lung metastases in a New Zealand population

Rebecca Geary, Nur Azri Bin Haji Mohd Yasin, Frank Lin, Deborah Whalley, Ziad Thotathil, Charles DeGroot

Stereotactic radiotherapy is the delivery of higher doses of precisely targeted radiotherapy in fewer treatments than conventional radiotherapy. This study demonstrates that the outcomes of stereotactic radiotherapy in Waikato, when used to treat both lung cancer and cancer that has spread to the lungs, are similar to the outcomes reported from other centres around the world. However, Māori patients with lung cancer have worse outcomes with stereotactic lung radiotherapy than non-Māori patients, despite similar tumour characteristics.

Article

SUMMARY

Estimating the effect of selective border relaxation on COVID-19 in New Zealand | OPEN ACCESS

Benjamin J Smith, Arthur J Morris, Ben Johnston, Stephen Child, Simon Thornley

A data scientist, with a group of senior doctors, have modelled the effect of tailoring border testing and quarantine policy that would enable some international travel from countries where COVID-19 is rare. New Zealand now maintains low levels of COVID-19 in the community, with two-week quarantine, and now predeparture tests, being required for travellers from many regions. Data scientist and lead author, Dr Ben Smith, says: “We have explored how the risk to New Zealanders could be estimated based on how common COVID-19 is in the traveller’s country of origin and the safeguards in place across the traveller journey… By tailoring border, testing and quarantine requirements to a traveller’s country, New Zealand could increase international travel from countries with very low levels of COVID-19 while keeping community exposure to the virus to very low levels.”

Viewpoint

SUMMARY

COVID-19 outbreak management in a hospital ward: lessons learned to prevent, prepare for and respond to infectious disease outbreaks in healthcare settings | OPEN ACCESS

Catherine Habel, Jerome Ng, Phil Shoemack, Kate Grimwade, Fiona Miller, Jen Boryer, Hayley Bennett, Stephanie Chisholm

A number of COVID-19 outbreak clusters occurred across New Zealand. One such occurrence was in a mental health hospital ward of a medium sized district health board (DHB). This manuscript reflects on the effective management of this COVID-19 outbreak and considers what could have been done better. Lessons learned are shared to support other health providers to improve their outbreak management.

Article

SUMMARY

Pacific peoples and alcohol: a review of the literature

Vili Hapaki Nosa, Gemma Malungahu, Janine Paynter, Dudley Gordon Ralph Gentles, David Newcombe

This is a scoping literature review of recent research exploring alcohol use by Pacific peoples in New Zealand. We conducted a scoping review of published and grey literature written and published between 2009 and 2019. Research was included if the study population, or a clearly identified subgroup of the study population, included one or more Pacific ethnicities and addressed alcohol use. Alcohol consumption by Pacific men has declined significantly, to 60% from 70%, in 2006/07. However, of those who consume alcohol, 46% meet the threshold for hazardous consumption. Alcohol consumption by Pacific youth has also declined.

Article

SUMMARY

The clinical workforce caring for emerging adults with diabetes in New Zealand is under resourced

Ryan Paul, Vickie Corbett

Diabetes is one of the most common disorders in emerging adults (15–25 years of age) and affects approximately 2,300 New Zealanders in this age group. Emerging adulthood is typically the hardest age group in which to achieve good glycaemic control (control of glucose levels), due to the high prevalence of psychosocial stressors and increased insulin resistance of puberty. Consequently, international guidelines recommend emerging adults with diabetes receive care from a dedicated multidisciplinary team consisting of an endocrinologist (specialist diabetes physician), diabetes nurse specialist, dietitian, psychologist and social worker or youth worker. Our survey of all 20 district health boards (DHBs) show that the clinical workforce caring for emerging adults with diabetes in New Zealand is significantly under resourced, with only twelve DHBs having a dedicated multidisciplinary team, only eight DHBs having dedicated dietitian staff, three DHBs having dedicated psychology staff and four DHBs having a dedicated social worker or youth worker/health navigator. Median staffing-to-patient ratios were at least three-fold less than international recommendations, more than ten-fold and thirty-fold less for dietitians and psychologists, respectively, and approximately half that of staff caring for children with diabetes in New Zealand. Despite the increasing prevalence of type 2 diabetes in emerging adults, no DHB had an intervention programme for type 2 diabetes in this age group.

Clinical Correspondence

SUMMARY

Cobalt toxicity: a preventable and treatable cause for possibly life threatening cardiomyopathy

Gabriella Giacon, Ken Boon

Cobalt is a metal ion that is commonly used in certain metal-on-metal joint replacements. Commonly, these joints can return patients’ mobility and independence. However, as this case report shows, serum cobalt levels can rise and cause a toxic effect on the heart. With rising serum levels can come greater damage, resulting in potentially irreversible cardiac damage and ultimately death.

Article

SUMMARY

Referral for investigation: a redundant SNOMED-CT chief presenting complaint

Peter G Jones, Mark Gardener

We audited the use of the non-specific chief presenting complaint ‘Referral for investigation’ for emergency department (ED) attendances and found that this was used around 5% of the time. In 94% of cases a more specific and useful chief presenting complaint was available. ‘Referral for investigation’ was used more often for the most urgent cases, meaning data quality was worse for the sickest or most severely injured patients. To improve data quality, we recommend that ‘Referral for investigation’ be removed from the ministry of health SNOMED-CT ED reference set.

Article

SUMMARY

Estimating the risk of outbreaks of COVID-19 associated with shore leave by merchant ship crews: simulation studies for New Zealand | OPEN ACCESS

Nick Wilson, Tony Blakely, Michael G Baker, Martin Eichner

We conducted a modelling study that aimed to estimate the risk of COVID-19 outbreaks in a COVID-19-free destination country (New Zealand) associated with shore leave by merchant ship crews who were infected prior to their departure or on their ship. We found that the introduction of SARS-CoV-2 through shore leave from international shipping crews is likely, even after long voyages. But the risk can be substantially mitigated by control measures such as PCR testing and mask use.

Editorial