Vol 134 No 1531: 12 March 2021

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Issue Summary

Article

SUMMARY

Regional distribution of myeloma in New Zealand

Mary Jane Sneyd, Andrew Gray, Ian Morison

Myeloma is one of the most common blood cancers worldwide. We examined whether there was any regional variation in myeloma occurrence in New Zealand and found no important differences in myeloma by region. Women had significantly fewer myelomas than men of the same ethnic group and region. As both the highest and lowest myeloma occurrence was in rural areas, it is unlikely that farming confers an increased risk of myeloma.

Clinical Correspondence

SUMMARY

An unusual case of spontaneous obstructive thrombus complicating rheumatic mitral stenosis

Shaun Collings, Andrew Borrie, Matthew Webber, Sean D Galvin

We describe a rare case of cardiac arrest in a patient whose heart valves are damaged due to rheumatic heart disease. This scarring caused an irregular heart rhythm (atrial fibrillation) and turbulent blood flow within the heart, which allowed thrombi (clot) to form. A thrombus spontaneously moved into the valve and blocked flow, leading to cardiac arrest and emergency cardiac surgery for a valve replacement. We believe the thrombus triggered further blood clots in other organs. This case describes the importance of having used trans-oesophageal echocardiogram (ultrasound via the oesophagus looking at the heart), rather than trans-thoracic echocardiogram (ultrasound from the chest wall looking at the heart), as this clot was not identified on trans-thoracic echocardiogram. Following emergency surgery, the patient made a full recovery.

Viewpoint

SUMMARY

Should prioritising health interventions be informed by modelling studies? The case of cancer control in Aotearoa New Zealand

Nick Wilson, Leah Grout, Jennifer Summers, Amanda C Jones, Anja Mizdrak, Nhung Nghiem, Cristina Cleghorn, Tony Blakely

In this article, we provide modelling evidence for informing the prioritisation of health interventions, specifically in the cancer control area. We show how decision-making can now be informed by many epidemiological and health economic analyses (eg, to cover the health gain, impact on Māori vs non-Māori health gains and costs (cost-savings) to the health system). These analyses span primary prevention of cancer (eg, tobacco control, dietary and physical activity interventions and HPV vaccination), cancer screening, cancer treatment and palliative care. We identify that the largest health gain and cost-savings from the available modelling work for New Zealand are particularly seen with nutrition and tobacco control interventions. Many of these interventions have potentially greater per capita health gain for Māori than non-Māori and are also found to be cost-saving to the health sector.

Article

SUMMARY

Can patient symptoms reliably predict major oesophageal motility disorders assessed by conventional water perfusion manometry?

Conrad Stranz, Thomas Watkinson, Andrea Cross, Peter Hamer, Ross Roberts

Over a period of almost 20 years, patients having pressure testing (manometry) of the oesophagus (gullet/food pipe) had their symptoms analysed to see whether a major motility disorder of the oesophagus could be identified. In the 546 patients studied, difficulty in swallowing, chest pain or difficulty in swallowing when challenged with bread were able to identify all major motility disorders, proven with manometry. If a clinician suspects a motility disorder of the oesophagus, manometry is preferred but clinical features can be very helpful.

Article

SUMMARY

Perceptions of competency with evidence-based medicine among medical students: changes through training and alignment with objective measures

Nicholas J Clode, Kirsty Danielson, Elizabeth Dennett

Evidence-based medicine (EBM) is the integration of best available research evidence alongside clinical experience and patient preferences in medical decision-making. In this investigation, medical students’ competence with EBM did not improve during their senior years of medical training. Medical students reported little observation of EBM in clinical environments, and this lack of explicit role modelling may be influencing students’ development of competency with EBM.

Article

SUMMARY

Do the ‘Eyes’ have it? How good are surgeons at identifying appendicitis macroscopically? A retrospective study in New Zealand

Rennie X Qin, Damien L Ah Yen

During an operation for suspected appendicitis, the surgeon assesses the appendix to determine whether it is inflamed or normal. In our study, we investigated the accuracy of surgeons’ macroscopic assessments of appendicitis during the operation. We found that these assessments lacked accuracy. In 9.1% of cases there was disagreement between surgeons’ assessments and the gold standard pathological assessment. 21.6% of appendixes that appeared normal to surgeons were found to have appendicitis by the pathologists.

Article

SUMMARY

Pre-diabetes prevalence and associated factors in New Zealand school children: a cross-sectional study

Hajar Mazahery, Cheryl S Gammon, Donna Lawgun, Cathryn A Conlon, Kathryn L Beck, Pamela R von Hurst

We used a large sample with broad representation of ethnic distribution in New Zealand to investigate the rate of pre-diabetes in children. The main findings of our study were that the prevalence of pre-diabetes was 16%, and it was higher in South Asian and Pacific Island children, those with lower physical-activity levels and those with higher waist circumference or body fat percentage. These findings suggest that signs of diabetes risk are detectable at a young age, supporting the need for appropriate and timely interventions to halt the progression to T2DM.

Article

SUMMARY

Nationwide dispensing of cardioprotective medications during the first year following acute coronary syndrome (ANZACS-QI 56)

Michael Butchard, Andrew J Kerr, Corina Grey, Billy Wu, Phil Hider

Everyone who has an acute coronary syndrome (heart attack) should take some key medications on discharge that have been proven to reduce deaths, such as a statin, aspirin and another antiplatelet or anticoagulant. Dispensing of these medications after discharge is lower than what would be expected if guidelines were followed. The greatest decrease in dispensing occurred between three to six months after discharge. This drop in dispensing is unlikely to be explained by side effects to the medicines, and it highlights an important point in time for targeted interventions to ensure people remain on their mediation.

Article

SUMMARY

The potential of school-based physical education to increase physical activity in Aotearoa New Zealand children and young people: a modelling study

Anja Mizdrak, Caroline Shaw, Bridgette Lynch, Justin Richards

This study looks at the impact of increasing school-based physical education (PE) on young people’s physical-activity levels. The study was based on data from the Sport New Zealand 2017/18 Active NZ Young People Survey of around 9,000 young people aged 5–17 years. If Aotearoa New Zealand increased the amount of PE time to be in-line with international best practice (2.5hours/week), the percentage of young people meeting physical-activity guidelines would increase. Importantly, increasing PE would increase physical activity in young people who are currently the least active and therefore have the most to gain from doing more physical activity.

Editorial