Vol 134 No 1533: 16 April 2021

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Issue Summary

Clinical Correspondence

SUMMARY

Apricot oil as a cause for multi-lobulated oil cysts in the deltoid muscle of a bodybuilder

Dominic P O’Dowd, David Dow, Michael P Rosenfeldt

The use of performance and image enhancing drugs (PIEDs) such as steroids presents a risk to patients due to the method in which PIEDs are obtained and the potential advice given on their use by non-medial advocates. Doctors in the community should ask patients about use if they suspect and discuss the potential side effects. Routine health screening in relation to side effects can be undertaken in the community when required.

Article

SUMMARY

A prospective audit on the use of prophylactic antiemetics and rates of CINV in patients receiving carboplatin AUC≥4 or combination anthracycline–cyclophosphamide

Edward Lo, Malcolm Anderson, Rebecca Carroll, Garry Forgeson, Richard Isaacs, Jody Jordan, Liyana Satterthwaite, Navin Wewala, Jennifer Fernando

Some chemotherapy drugs can cause nausea and vomiting for significant numbers of patients and international guidelines recommend routine anti-sickness drugs to be given to prevent this. Recent guideline updates have suggested adding additional drugs to reduce nausea and vomiting further. This audit assessed the current rate of nausea and vomiting for patients receiving chemotherapies known to cause high rates of nausea and vomiting in a New Zealand centre. It confirmed high rates of this side effect persisting and supports the addition of newer anti-sickness drugs to existing regimen in this group of patients.

Viewpoint

SUMMARY

The political economy of healthcare reform: why New Zealand has experienced 82 years of ineffectual reforms and what can be done about it

Murray Horn, Des Gorman

Universal healthcare, based on there being no cost for consumers, was partially realised in New Zealand in 1938, but an unresolved dispute with the medical profession meant that primary care remained privately provided. Escalating costs and inequality of provision have subsequently triggered multiple reviews and reforms. However, starting with the establishment of Area Heath Boards in 1983, none of these largely structural changes have either lasted or been able to fundamentally address these cost and equity issues in a sustainable manner. Given we seem imminently destined for yet more structural change, it is important to ask why these reforms have not been successful.

Article

SUMMARY

Doing what it takes: a qualitative study of New Zealand carers’ experiences of giving home-based palliative care to loved ones

Eileen McKinlay, Kalilea Vaipuna, Teresa O’Toole, Helen Golds, Astrid Adams

The study explored the views of New Zealand home carers providing home-based end of life care, as little is known about this in the New Zealand context. We interviewed nine bereaved carers whose loved ones had received a combination of hospice, district health board, home-support and general practitioner care. Two main themes emerged: (1) Home: a place of safety and self-determination; (2) Doing what it takes. The study showed that, while carers are grateful for professionals and family/whānau/friend support, they experience challenges caring for loved ones at end of life in the home. These could be addressed by a systematic supply of information about how to assess needs and when to give medicines; ensuring carers have information regarding which professional and agency does what and who to contact for help; supporting carers to take on a leadership role if this is what they want; undertaking a regular review about the decision to provide care at home; providing post-bereavement support to carers for longer than is currently being given.

Article

SUMMARY

Mortality and fluctuations in macroeconomic activity in New Zealand

Ryan Greenaway-McGrevy

Mortality rates in New Zealand exhibit both short-run procyclical features and long-run countercyclical features. Although elderly mortality rates have been decreasing over the post-war period, reductions in elderly mortality accelerated during periods of increasing unemployment. In contrast, deaths from suicides and assaults exhibited a positive long-run statistical relationship with the unemployment rate, meaning that periods of high unemployment were associated with increased suicides and assaults resulting in death.

Viewpoint

SUMMARY

All-of-community by all-of-government: reaching Pacific people in Aotearoa New Zealand during the COVID-19 pandemic | OPEN ACCESS

Julia Ioane, Teuila Percival, Winnie Laban, Ian Lambie

A response to COVID-19 for Pacific and vulnerable communities requires the provision of health-promotion messages that incorporate health inequities and social justice principles by undertaking a holistic approach that is not confined to a western definition of health needs and includes (though is not limited to) faith-based and spiritual context. An all-of-community approach responds to the recommendation that a best practice plan for COVID-19 and beyond requires transparency in the decision-making process. Community involvement is more likely to provide this transparency to build and sustain Pacific confidence and trust in government. Consonant with the Pacific collective worldview, if support for families can transition to self-sufficiency, this will result in more sustainable outcomes for communities. The successful management and elimination of a pandemic should be assessed by how well Pacific and vulnerable communities survive during such crises and beyond.

Article

SUMMARY

Care of patients with early inflammatory arthritis in the Wellington region according to the British Society of Rheumatology's best practice tariff standards

Hamish J Farquhar, William J Taylor

Early commencement of appropriate medical therapy, usually by specialist rheumatology services, has been shown to improve the outcomes of people with inflammatory arthritis, especially rheumatoid arthritis. However, our audit of waiting times in the Wellington region showed that people with possible inflammatory arthritis wait much longer (average of 11 weeks) to be seen after referral by their family doctor, rather than the three weeks recommended by the British Society of Rheumatology. Probably more rheumatologists and more flexibility in arranging faster appointments are needed.

Article

SUMMARY

Caesarean scar ectopic pregnancy: a case series and case report to highlight the experience in regional New Zealand

Katherine Maslowski, Simon Scheck, Sikhar Sircar, Henry Liu

Caesarean scar pregnancy (CSP) is when a pregnancy implants within a previous caesarean section scar within the uterus (womb). This carries a very high risk to the women (including death), and it is recommended that these pregnancies not continue. The management of this situation is variable across different locations and the scientific literature does not provide much guidance as to the best method. We report ten cases of CSP treated at Palmerston North Hospital over a five-year period and the first treatment option was successful in seven of these cases. Our findings would support the creation of a national register for CSP in New Zealand to improve diagnosis and treatment.

Article

SUMMARY

Inequity in outcomes from New Zealand chronic pain services

Gwyn N Lewis, Robert Borotkanics, Angela Upsdell

We looked at clinical outcome measures (pain, physical function, mental health) from a database of people who had attended a New Zealand chronic-pain service. These outcomes were compared between ethnicities (Māori, Pacific people, Asian, European) at baseline, treatment end and at 3–6-month follow-up. At baseline, scores in the outcome measures were consistently worse in the non-European ethnicities. At treatment end, Pacific people had poorer scores compared to European for several measures of mental health. At 3–6-month follow-up almost all outcome measures were poorer for Māori compared to European, and several of the mental health measures were poorer for Asian and Pacific people. These findings indicate ethnic inequalities in treatment efficacy of New Zealand chronic pain services and indicate a review of cultural safety of the services is required.

Article

SUMMARY

Childhood asthma in New Zealand: the impact of on-going socioeconomic disadvantage (2010–2019)

Deborah Schlichting, Tayaza Fadason, Cameron C. Grant, Justin O’Sullivan

Asthma is one of the most common childhood illnesses. Approximately 13% of New Zealand children have asthma. With good primary care, asthma can be well managed. However, many children do not get adequate primary care for asthma. This is particularly true for children of Māori ethnicity and children living in households in areas of high deprivation. These groups of children get more asthma reliever medication, fewer asthma preventer medication prescriptions and are hospitalised and readmitted more frequently for asthma than children of non-Māori ethnicity living in neighbourhoods of comparable deprivation. These inequities increase in winter. Such inequities have been known since at least the early 1990s. Sadly, despite overall reductions in numbers of hospitalisations for childhood asthma, these inequities persist. Some children continue to get better primary care for their asthma than other children.

Editorial