Issue

Vol 134 No 1536: 4 June 2021

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Issue Summary

Article
SUMMARY

Improving the prescribing practice of junior doctors through interprofessional collaboration and evidence-based education

Dale Sheehan, Avril Lee, Arindam Basu, John Thwaites

This paper explains how two district health boards medical education units adapted a UK educational approach to reduce prescribing errors by junior doctors in their first year of practice, using pharmacist’s expertise as clinical coaches. The impact was measured on patient care, using prescribing error data across a six-month period. The research showed that not only is it possible to accelerate prescribing performance of new prescribers, but the participants’ experience was practical and relevant. The research team are currently exploring how to scale up this work for entire cohorts of junior doctors and build sustainability into the process.

Article
SUMMARY

What helps and hinders metformin adherence and persistence: a qualitative study exploring the views of people with type 2 diabetes

Lianne Parkin, Karyn Maclennan, Lisa Te Morenga, Marie Inder, Losa Moata'ane

Metformin is the first-line treatment for type 2 diabetes. Our wider research group recently examined national pharmaceutical dispensing data and found that metformin adherence (taking metformin as prescribed) and persistence (continuing to take metformin) varied by patient characteristics such as age and ethnicity. Although the work provided a good overview of how metformin is being used in New Zealand, it did not provide any information about patient perspectives on the enablers of, and barriers to, optimal adherence and persistence. We interviewed 10 Māori, 10 Pacific and 10 non-Māori non-Pacific patients who had started metformin within the previous two years, and we identified several barriers to metformin adherence and persistence—these included delays in accepting the diagnosis of type 2 diabetes, the cost of visiting a doctor and prescription charges, complex and busy lives and feelings of guilt and shame about having diabetes and/or poor control of blood sugars that prevented people from visiting their doctor. Participants’ comments highlighted the importance of developing and maintaining good patient–healthcare provider relationships and tailoring communication styles to the preferences of patients; some Māori and Pacific participants also emphasised the importance of having Māori and Pacific healthcare providers who share their cultural identity and language.

Article
SUMMARY

The emergence of azole resistance in Aspergillus fumigatus complex in New Zealand

Wendy P McKinney, Anna Vesty, Jaideep Sood, Hasan Bhally, Arthur J Morris

Aspergillus fumigatus causes serious infections that are difficult to treat with high mortality. The most commonly used treatments are anti-fungal drugs called azoles. Resistance to azoles is common in some countries and we are now seeing resistant strains in New Zealand. There should be improved access (ie, funding) to appropriate antifungal agents for certain Aspergillus infections in New Zealand.

Article
SUMMARY

Primary medication non-adherence to analgesics and antibiotics at Counties Manukau Health Emergency Department

Nataly Martini, Bert van der Werf, Deborah Bassett-Clarke

The study investigated whether patients discharged from Counties Manukau Health Emergency Department had their prescriptions for antibiotics, paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) filled. The majority of patients in the study were New Zealand-born (67%), of Pacific Island descent (43%), living in the most socioeconomically deprived areas (78%) and under the age of 10 years (33%). Almost half of the patients in the study did not fill all of the medicines on their prescription with smokers and those aged between 10 and 44 years most likely to not to fill their prescriptions. Filling rates increased significantly if more than one medicine was prescribed. Antibiotics were most likely to be filled, and NSAIDs were significantly more likely to be filled compared with paracetamol.

Article
SUMMARY

Complications of endoscopically placed duodenal stents for malignant duodenal outlet obstruction

Anurag Sekra, Vijay Dyavadi, Qiuyu Jin, Ravinder Ogra

A duodenal stent is a piece of metal that is placed across blockage in the duodenum from cancer. It is placed with the help of an endoscope (flexible camera). This is a safe and extremely effective procedure to improve symptoms of blockage and our study highlights this.

Article
SUMMARY

Patch testing to plants: sensitisation associated with exposure to plants, essential oils and botanicals in cosmetics

Victoria L Murphy, Denesh C Patel, Steven R Lamb, Harriet S Cheng

Contact allergy to plants presents with dermatitis and is diagnosed with skin patch testing. Reactions to plant allergens were found to be related to botanicals in cosmetics and creams, plants and essential oils. Rates of plant sensitisation (positive patch-testing reactions) in our cohort are comparable with international data.

Article
SUMMARY

Ciguatera poisoning and confirmation of ciguatoxins in fish imported into New Zealand

J. Sam Murray, D. Tim Harwood, Lesley Rhodes

As the global need for protein is growing exponentially, countries are now looking at tropical reef fish from the Pacific region to meet this demand. In turn, this means the risk of people being exposed to ciguatera poisoning, the most common non-microbial food borne illness in the world, is rapidly growing, highlighting the importance of raising awareness of this tropical disease. One such example is the recent intoxication event that happened in Christchurch, New Zealand. Five people became ill after consuming imported Fiji Kawakawa, a commonly caught grouper species, and upon hospitalisation were clinically diagnosed as having ciguatera poisoning. Meal remnants were then tested by scientists at Cawthron Institute and confirmed the presence of ciguatoxins, the causative compounds of this poisoning syndrome.

Viewpoint
SUMMARY

Care planning, diagnosis and management in paediatric functional constipation

Darryl Cochrane

Paediatric constipation is a chronic condition and its treatment requires medication to keep the stool soft and behavioural interventions. A thorough history, including questions about the frequency of bowel movements and stool type, is required. If no red flags are found after examining the abdomen, spine, lower limbs and perianal area, the practitioner should have confidence to aggressively manage the constipation through a constipation action plan.

Viewpoint
SUMMARY

Participant injury in clinical trials conducted in New Zealand for the benefit of manufacturers: an unfair system?

Mark Bolland

When injuries occur in trials conducted in New Zealand for the benefit of the manufacturer, trial participants are excluded from ACC coverage. Injured trial participants therefore need to seek compensation from the trial sponsor. The article describes a case where a trial participant suffered a rare illness that the treating doctors thought related to participating in the trial. It took more than six years for the case to be settled and was a long and arduous process for the participant that ultimately required legal assistance. The case demonstrates that the current system is not fair for this group of trial participants and needs to change. Most of these trial participants will not be aware of the difficulties they may face if they become injured. Any change requires political input, but a simple solution would be to repeal the specific section of the current ACC Act that excludes these trials from ACC coverage, meaning all trial participants would be covered by ACC. Any costs could be met by charging trial sponsors a levy.

Editorial
SUMMARY

“We have been warned”—preparing now to prevent the next pandemic | OPEN ACCESS

David R Murdoch, Sue Crengle, Bob Frame, Nigel P French, Patricia C Priest

The recently released report by the Independent Panel for Pandemic Preparedness & Response, co-chaired by Helen Clark, is highly critical of the global response to the COVID-19 pandemic. The report makes several recommendations on how countries can better prepare to prevent future similar events, and urges that action needs to be taken from now. As much as any other nation, New Zealand needs to reflect on this report. Despite having done relatively well by global standards in our response to COVID-19, there are still some actions we need to take now to better prepare for the next pandemic.

ALL ARTICLES
SUMMARY
Editorial
Vol 134 No 1536: 4 June 2021

“We have been warned”—preparing now to prevent the next pandemic | OPEN ACCESS

David R Murdoch, Sue Crengle, Bob Frame, Nigel P French, Patricia C Priest

‘COVID-19: Make it the Last Pandemic’ is the aspirational title of the recently released report by the Independent Panel for Pandemic Preparedness and Response.

Article
Vol 134 No 1536: 4 June 2021

Improving the prescribing practice of junior doctors through interprofessional collaboration and evidence-based education

Dale Sheehan, Avril Lee, Arindam Basu, John Thwaites

The last decade (2010–2019) has seen calls to action to improve the prescribing practice of junior doctors.

Article
Vol 134 No 1536: 4 June 2021

What helps and hinders metformin adherence and persistence: a qualitative study exploring the views of people with type 2 diabetes

Lianne Parkin, Karyn Maclennan, Lisa Te Morenga, Marie Inder, Losa Moata'ane

Type 2 diabetes is a major public health issue globally and in New Zealand.

Article
Vol 134 No 1536: 4 June 2021

The emergence of azole resistance in Aspergillus fumigatus complex in New Zealand

Wendy P McKinney, Anna Vesty, Jaideep Sood, Hasan Bhally, Arthur J Morris

Aspergillus spp. are the most common cause of invasive mould infections globally.

Article
Vol 134 No 1536: 4 June 2021

Primary medication non-adherence to analgesics and antibiotics at Counties Manukau Health Emergency Department

Nataly Martini, Bert van der Werf, Deborah Bassett-Clarke

For medication to be therapeutically effective, it is essential that patients adhere to them. Filling a prescription is the first critical step to establish medication adherence.

Article
Vol 134 No 1536: 4 June 2021

Complications of endoscopically placed duodenal stents for malignant duodenal outlet obstruction

Anurag Sekra, Vijay Dyavadi, Qiuyu Jin, Ravinder Ogra

Malignant duodenal stenosis is a common presentation of inoperable metastatic pancreatic cancer. It can be observed in up to 15% of patients.

Article

Patch testing to plants: sensitisation associated with exposure to plants, essential oils and botanicals in cosmetics

Victoria L Murphy, Denesh C Patel, Steven R Lamb, Harriet S Cheng

Contact with plants may cause plant dermatitis (phytodermatitis) due to allergic, irritant and photosensitive (phytophotodermatitis) mechanisms.

Article
Vol 134 No 1536: 4 June 2021

Ciguatera poisoning and confirmation of ciguatoxins in fish imported into New Zealand

J. Sam Murray, D. Tim Harwood, Lesley Rhodes

Ciguatera poisoning (CP) is the most common non-microbial food-borne illness in the world.

Clinical Correspondence
Vol 134 No 1536: 4 June 2021

Evaluating barriers to access for cataract surgery in Waikato: analysis of calculated driving distance and visual acuity

Ben Wilkinson, James McKelvie

The World Health Organization (WHO) suggests that equitable access to quality healthcare is an essential goal of any health system.

Viewpoint
Vol 134 No 1536: 4 June 2021

Care planning, diagnosis and management in paediatric functional constipation

Darryl Cochrane

Paediatric functional constipation is a growing medical condition in New Zealand and worldwide, with a reported average prevalence of ~12% (range 0.5% to 32.2%).

Viewpoint
Vol 134 No 1536: 4 June 2021

Participant injury in clinical trials conducted in New Zealand for the benefit of manufacturers: an unfair system?

Mark Bolland

In New Zealand, participants in clinical trials that are deemed as being conducted for the benefit of the manufacturer are not eligible for Accident Compensation Corporation (ACC) coverage if they suffer an injury from participating in the trial.

Clinical Correspondence
Vol 134 No 1536: 4 June 2021

Anti-NMDA receptor autoimmune encephalitis

Akram Shmendi, Stewart Shiu

A 42-year-old, previously healthy female presented to her local doctor with insomnia, difficulty concentrating and impaired short-term memory.

Letter
Vol 134 No 1536: 4 June 2021

Letter on an iceberg | OPEN ACCESS

Cheri Hotu, Sandra Hotu, Dawn Adair, Danny De Lore, Clarence Kerrison, George Laking, Myra Ruka, Kennedy Sarich, Jade Tamatea, Tane Taylor, Matthew Wheeler

We write as the Māori Health Committee of the Royal Australasian College of Physicians (RACP), a collective of Māori physician and paediatrician Fellows and trainees.

100 Years Ago in the NZMJ
Vol 134 No 1536: 4 June 2021

A Case of Congenital Absence of Pericardium and Left Half of Diaphragm

While diaphragmatic hernia of traumatic origin is comparatively common, especially since the war, hernia resulting from congenital defects in the diaphragm is only rarely recorded.

Proceedings
Vol 134 No 1536: 4 June 2021

Proceedings of the Waikato Clinical Campus Research Seminar, Wednesday 31 March 2021

Editorial
SUMMARY

“We have been warned”—preparing now to prevent the next pandemic | OPEN ACCESS

David R Murdoch, Sue Crengle, Bob Frame, Nigel P French, Patricia C Priest

The recently released report by the Independent Panel for Pandemic Preparedness & Response, co-chaired by Helen Clark, is highly critical of the global response to the COVID-19 pandemic. The report makes several recommendations on how countries can better prepare to prevent future similar events, and urges that action needs to be taken from now. As much as any other nation, New Zealand needs to reflect on this report. Despite having done relatively well by global standards in our response to COVID-19, there are still some actions we need to take now to better prepare for the next pandemic.

Article
SUMMARY

Improving the prescribing practice of junior doctors through interprofessional collaboration and evidence-based education

Dale Sheehan, Avril Lee, Arindam Basu, John Thwaites

This paper explains how two district health boards medical education units adapted a UK educational approach to reduce prescribing errors by junior doctors in their first year of practice, using pharmacist’s expertise as clinical coaches. The impact was measured on patient care, using prescribing error data across a six-month period. The research showed that not only is it possible to accelerate prescribing performance of new prescribers, but the participants’ experience was practical and relevant. The research team are currently exploring how to scale up this work for entire cohorts of junior doctors and build sustainability into the process.

Article
SUMMARY

What helps and hinders metformin adherence and persistence: a qualitative study exploring the views of people with type 2 diabetes

Lianne Parkin, Karyn Maclennan, Lisa Te Morenga, Marie Inder, Losa Moata'ane

Metformin is the first-line treatment for type 2 diabetes. Our wider research group recently examined national pharmaceutical dispensing data and found that metformin adherence (taking metformin as prescribed) and persistence (continuing to take metformin) varied by patient characteristics such as age and ethnicity. Although the work provided a good overview of how metformin is being used in New Zealand, it did not provide any information about patient perspectives on the enablers of, and barriers to, optimal adherence and persistence. We interviewed 10 Māori, 10 Pacific and 10 non-Māori non-Pacific patients who had started metformin within the previous two years, and we identified several barriers to metformin adherence and persistence—these included delays in accepting the diagnosis of type 2 diabetes, the cost of visiting a doctor and prescription charges, complex and busy lives and feelings of guilt and shame about having diabetes and/or poor control of blood sugars that prevented people from visiting their doctor. Participants’ comments highlighted the importance of developing and maintaining good patient–healthcare provider relationships and tailoring communication styles to the preferences of patients; some Māori and Pacific participants also emphasised the importance of having Māori and Pacific healthcare providers who share their cultural identity and language.

Article
SUMMARY

The emergence of azole resistance in Aspergillus fumigatus complex in New Zealand

Wendy P McKinney, Anna Vesty, Jaideep Sood, Hasan Bhally, Arthur J Morris

Aspergillus fumigatus causes serious infections that are difficult to treat with high mortality. The most commonly used treatments are anti-fungal drugs called azoles. Resistance to azoles is common in some countries and we are now seeing resistant strains in New Zealand. There should be improved access (ie, funding) to appropriate antifungal agents for certain Aspergillus infections in New Zealand.

Article
SUMMARY

Primary medication non-adherence to analgesics and antibiotics at Counties Manukau Health Emergency Department

Nataly Martini, Bert van der Werf, Deborah Bassett-Clarke

The study investigated whether patients discharged from Counties Manukau Health Emergency Department had their prescriptions for antibiotics, paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) filled. The majority of patients in the study were New Zealand-born (67%), of Pacific Island descent (43%), living in the most socioeconomically deprived areas (78%) and under the age of 10 years (33%). Almost half of the patients in the study did not fill all of the medicines on their prescription with smokers and those aged between 10 and 44 years most likely to not to fill their prescriptions. Filling rates increased significantly if more than one medicine was prescribed. Antibiotics were most likely to be filled, and NSAIDs were significantly more likely to be filled compared with paracetamol.

Article
SUMMARY

Complications of endoscopically placed duodenal stents for malignant duodenal outlet obstruction

Anurag Sekra, Vijay Dyavadi, Qiuyu Jin, Ravinder Ogra

A duodenal stent is a piece of metal that is placed across blockage in the duodenum from cancer. It is placed with the help of an endoscope (flexible camera). This is a safe and extremely effective procedure to improve symptoms of blockage and our study highlights this.

Article
SUMMARY

Patch testing to plants: sensitisation associated with exposure to plants, essential oils and botanicals in cosmetics

Victoria L Murphy, Denesh C Patel, Steven R Lamb, Harriet S Cheng

Contact allergy to plants presents with dermatitis and is diagnosed with skin patch testing. Reactions to plant allergens were found to be related to botanicals in cosmetics and creams, plants and essential oils. Rates of plant sensitisation (positive patch-testing reactions) in our cohort are comparable with international data.

Article
SUMMARY

Ciguatera poisoning and confirmation of ciguatoxins in fish imported into New Zealand

J. Sam Murray, D. Tim Harwood, Lesley Rhodes

As the global need for protein is growing exponentially, countries are now looking at tropical reef fish from the Pacific region to meet this demand. In turn, this means the risk of people being exposed to ciguatera poisoning, the most common non-microbial food borne illness in the world, is rapidly growing, highlighting the importance of raising awareness of this tropical disease. One such example is the recent intoxication event that happened in Christchurch, New Zealand. Five people became ill after consuming imported Fiji Kawakawa, a commonly caught grouper species, and upon hospitalisation were clinically diagnosed as having ciguatera poisoning. Meal remnants were then tested by scientists at Cawthron Institute and confirmed the presence of ciguatoxins, the causative compounds of this poisoning syndrome.

Viewpoint
SUMMARY

Care planning, diagnosis and management in paediatric functional constipation

Darryl Cochrane

Paediatric constipation is a chronic condition and its treatment requires medication to keep the stool soft and behavioural interventions. A thorough history, including questions about the frequency of bowel movements and stool type, is required. If no red flags are found after examining the abdomen, spine, lower limbs and perianal area, the practitioner should have confidence to aggressively manage the constipation through a constipation action plan.

Viewpoint
SUMMARY

Participant injury in clinical trials conducted in New Zealand for the benefit of manufacturers: an unfair system?

Mark Bolland

When injuries occur in trials conducted in New Zealand for the benefit of the manufacturer, trial participants are excluded from ACC coverage. Injured trial participants therefore need to seek compensation from the trial sponsor. The article describes a case where a trial participant suffered a rare illness that the treating doctors thought related to participating in the trial. It took more than six years for the case to be settled and was a long and arduous process for the participant that ultimately required legal assistance. The case demonstrates that the current system is not fair for this group of trial participants and needs to change. Most of these trial participants will not be aware of the difficulties they may face if they become injured. Any change requires political input, but a simple solution would be to repeal the specific section of the current ACC Act that excludes these trials from ACC coverage, meaning all trial participants would be covered by ACC. Any costs could be met by charging trial sponsors a levy.

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