Issue

Vol 134 No 1537: 25 June 2021

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Issue Summary

Article
SUMMARY

Antipsychotic and sedative medication use in long-term care facilities providing dementia care

Etuini Ma’u, Janine Burton, Elizabeth Fussell

This study aimed to quantify the use of antipsychotic and sedative medications in residents with dementia in long-term care facilities in the Waikato and identify factors associated with the prescription of these medications. Despite the increasing evidence around the relatively poor efficacy and increased risks associated with antipsychotic and sedative prescription in individuals with dementia, this study shows the use of these medications in dementia care and psychogeriatric facilities remains high, with 48.2% of residents in this study currently prescribed an antipsychotic and 22.1% prescribed a sedative. Furthermore, less than 20% of those prescribed an antipsychotic or a sedative had the most recent dose change occur within the 12 weeks recommended by guidelines, with over 30% of those prescribed an antipsychotic and 48% of those prescribed a sedative not having their dose adjusted for over a year. With clear evidence of the risks of antipsychotics in dementia, the proportion of residents prescribed an antipsychotic or sedative in this study, in conjunction with the prolonged duration of prescription, is cause for concern and needs addressing.

Article
SUMMARY

Does research help to inform a district health board’s purpose? A qualitative thematic analysis of clinician researcher views

Lorraine Neave, Duncan Reid, Brian McKenna

This study explored, from a district health board (DHB) staff perspective, what the enablers and barriers to doing research were and whether the outcomes of research activity helped it deliver best care. It has provided insight into how organisational factors can negatively influence engagement in and with research and thereby impact the potential for research to inform the DHB’s overarching purpose. These factors are all modifiable influences. The themes offer a direction for the DHB’s future research strategy, where research activity is integrated into practice, where research evidence is discussed and where research achievements are celebrated. The findings from this study will likely resonate across New Zealand’s DHB landscape.

Article
SUMMARY

How common are non-acute coronary syndrome (ACS) diagnoses in patients with suspected ACS investigated with coronary angiography in New Zealand? (ANZACS-QI 58)

Charles Yao-Cheng Ho, Mildred Lee, Seif El-Jack, Peter Barr, Mark Simmonds, Gerry Devlin, Philip D Adamson, Michael Williams, Andrew J Kerr

Falsely activated coronary catheter laboratories for acute ST elevation heart attacks are low in New Zealand. Non-ACS conditions receiving invasive coronary angiography varies between DHBs requires more investigation.

Article
SUMMARY

Spatial, temporal and socioeconomic patterns of illicit drug use in New Zealand assessed using wastewater-based epidemiology timed to coincide with the census

Mackay Price, Chris Wilkins, Benjamin J Tscharke, Tom Baker, Jochen F Mueller, Sam Trowsdale

Wastewater samples were collected across seven sites in three regions of New Zealand to coincide with the 2018 census. This provided a way to quantify drug use and sociodemographics and assess the accuracy of drug survey techniques. The data show the expected regional, sub-regional and temporal patterns of illicit drug use, such as more MDMA consumed on the weekends than during the week. The key take home messages is that, in combination with complementary data like censuses, surveys and seizure information, wastewater analysis can help guide harm reduction policy for the wellbeing of New Zealand.

Article
SUMMARY

Reducing the MRI outpatient waiting list through a capacity and demand time series improvement programme

Heera Bhullar, Bernadette County, Stuart Barnard, Anne Anderson, Mary E Seddon

A partnership between Ko Awatea and the radiology department at Counties Manukau District Health Board aimed to match the demand for magnetic resonance imaging (MRI) with the available capacity. Using quality improvement techniques, the team successfully and sustainably reduced the MRI waiting list over a two-year period, reducing the number of patients waiting from nearly 2,000 to just over 400. The innovative solutions to segment the waiting list and match capacity to demand may be instructive for other radiology departments, and other waiting list scenarios.

Clinical Correspondence
SUMMARY

Zoledronate-induced anterior uveitis, scleritis and optic neuritis: a case report

Laura E Wolpert, Andrew R Watts

Zoledronate, a bisphosphonate medication used to treat osteoporosis, can cause inflammation of different parts of the eye. Inflammation of the iris, known as anterior uveitis, happens in about 1% of people treated with bisphosphonates. This paper describes a case of a female patient who developed inflammation of the iris, the sclera (the white of the eye) and the optic nerve following treatment with zoledronate.

Letter
SUMMARY

The competition is next door! Why a voluntary approach to tobacco retailer reduction will never work

Richard Portch

This paper describes the distribution of tobacco retailers across Tamaki Mākaurau and compares them with community pharmacies. We used a new methodology for attributing the deprivation and demographics of neighbourhood surrounding each retailer. Our research identified significant differences in how tobacco retailers and community pharmacies are distributed across the region, including that tobacco retailers are more likely to be in residential areas than community pharmacies and are more likely to have another tobacco retailer in close proximity to their location.

Article
SUMMARY

Social impacts and costs of schizophrenia: a national cohort study using New Zealand linked administrative data

Sheree Gibb, Naomi Brewer, Nicholas Bowden

We used data for the whole New Zealand population to compare people diagnosed with schizophrenia to similar people without schizophrenia. Compared to people without schizophrenia, people with schizophrenia experienced more adverse outcomes, including: unemployment; lower income; contact with the criminal justice system; and hospitalisation (for both mental and physical health reasons). The government costs (money spent by the New Zealand government on people’s social, health and other services) were six times higher for people living with schizophrenia than for people without schizophrenia. The biggest cost differences were in healthcare, benefits and social housing.

Viewpoint
SUMMARY

Cannabis Legalisation and Control Bill: should doctors be concerned?

Guna Kanniah, Shailesh Kumar

The regulatory and policy changes about legalising cannabis correlate with heightened acceptance, reduced perception of risks and an increase in cannabis use in both adults and adolescents, and controlled access to cannabis can be associated with better outcomes. The evidence for use in treating psychiatric illnesses is still lacking, and people who at a greater risk of experiencing adverse mental health outcomes will still be vulnerable under the proposed legislation. Regular cannabis use predicts an increased risk of schizophrenia. Cannabis is known to disproportionately harm people who have either a risk of mental illnesses or have existing mental illness. This significant at-risk population will not be protected by the proposed legislation in its current form. Data from other countries showing the beneficial effects of cannabis use in psychiatric populations are limited and conflicting, and potential harms in patients with psychotic and mood disorders have been increasingly documented. Further high-quality studies examining the effect of cannabis/cannabinoids on mental disorders are needed before any such policy changes.

ALL ARTICLES
SUMMARY
Article
Vol 134 No 1537: 25 June 2021

Antipsychotic and sedative medication use in long-term care facilities providing dementia care

Etuini Ma’u, Janine Burton, Elizabeth Fussell

As the proportion of the New Zealand population aged 65 years and older increases, there will be a concomitant increase in dementia cases.

Article
Vol 134 No 1537: 25 June 2021

Does research help to inform a district health board’s purpose? A qualitative thematic analysis of clinician researcher views

Lorraine Neave, Duncan Reid, Brian McKenna

A research-enabled environment can engender intellectual curiosity, positive questioning of routine practice and robust research practices that can lift process and practice in general.

Article
Vol 134 No 1537: 25 June 2021

How common are non-acute coronary syndrome (ACS) diagnoses in patients with suspected ACS investigated with coronary angiography in New Zealand? (ANZACS-QI 58)

Charles Yao-Cheng Ho, Mildred Lee, Seif El-Jack, Peter Barr, Mark Simmonds, Gerry Devlin, Philip D Adamson, Michael Williams, Andrew J Kerr

Over the past two decades, there has been a decline in the incidence of acute coronary syndrome (ACS) and associated mortality worldwide, including in New Zealand.

Editorial
Vol 134 No 1537: 25 June 2021

Improving care, reducing the burden

Wayne Miles

The conclusion from a meta-analysis of studies of the economic burden of schizophrenia was that the enormous burden is suggestive of the inadequate provision of healthcare services to patients with schizophrenia.

Article
Vol 134 No 1537: 25 June 2021

Social impacts and costs of schizophrenia: a national cohort study using New Zealand linked administrative data

Sheree Gibb, Naomi Brewer, Nicholas Bowden

Schizophrenia is a chronic and disruptive illness and has been ranked one of the top 25 causes of disability globally.

Article
Vol 134 No 1537: 25 June 2021

Spatial, temporal and socioeconomic patterns of illicit drug use in New Zealand assessed using wastewater-based epidemiology timed to coincide with the census

Mackay Price, Chris Wilkins, Benjamin J Tscharke, Tom Baker, Jochen F Mueller, Sam Trowsdale

Accurate and timely information about drug consumption is important for informing health and enforcement policy. Such information is often obtained from population surveys, drug seizures and hospital and drug treatment admissions, which have important limitations.

Article
Vol 134 No 1537: 25 June 2021

Reducing the MRI outpatient waiting list through a capacity and demand time series improvement programme

Heera Bhullar, Bernadette County, Stuart Barnard, Anne Anderson, Mary E Seddon

In 2018 an additional magnetic resonance imaging (MRI) machine was purchased, bringing the Counties Manukau District Health Board (CMDHB) total to three.

Viewpoint
Vol 134 No 1537: 25 June 2021

Cannabis Legalisation and Control Bill: should doctors be concerned?

Guna Kanniah, Shailesh Kumar

Cannabis is the most commonly used illegal drug in New Zealand, even though the unauthorised possession of any amount of cannabis is a crime under the Misuse of Drugs Act 1975.

Clinical Correspondence
Vol 134 No 1537: 25 June 2021

Zoledronate-induced anterior uveitis, scleritis and optic neuritis: a case report

Laura E Wolpert, Andrew R Watts

Bisphosphonates, such as zoledronate, are used by approximately 55,000 people per year in New Zealand to prevent the loss of bone density in a range of conditions such as osteoporosis, Paget’s disease of the bone and bone metastases.

Clinical Correspondence
Vol 134 No 1537: 25 June 2021

Endogenous endophthalmitis following computerised tomography colonography

Deepesh Mehta, Helen Long, Neil Aburn

Endogenous endophthalmitis is a rare and potentially blinding condition resulting from infection within the ocular tissues and accounts for 10% of all endophthalmitis cases.

Clinical Correspondence
Vol 134 No 1537: 25 June 2021

Vildagliptin-induced bullous pemphigoid

Annabelle Yi Zhang, Paul Jarrett

Bullous pemphigoid is an autoimmune blistering disorder that typically affects the elderly.

Letter
Vol 134 No 1537: 25 June 2021

The competition is next door! Why a voluntary approach to tobacco retailer reduction will never work

Richard Portch

In 2011, Te Kāwanatanga o Aotearoa (The New Zealand Government) set the goal to become smokefree by 2025 and have less than 5% of the population smoking daily.

100 Years Ago in the NZMJ
Vol 134 No 1537: 25 June 2021

Rupture of the Urinary Bladder

J.H., aged 65, arrived at Queenstown by boat at 7.30 p.m. on 27th April, 1921.

Proceedings
Vol 134 No 1537: 25 June 2021

Proceedings for the 256th Otago Medical School Research Society Masters/Honours Student Speak Awards, Wednesday 4 November 2020

Proceedings
Vol 134 No 1537: 25 June 2021

Proceedings for the 254th Otago Medical School Research Society Research Speaker Awards. Wednesday 24 June 2020

Proceedings
Vol 134 No 1537: 25 June 2021

Abstracts for the 255th Otago Medical School Research Society PhD Student Speaker Awards, Wednesday 19 August 2020

Proceedings
Vol 134 No 1537: 25 June 2021

Abstracts for the 253rd Otago Medical School Research Society Summer Student Sepeaker Awards, Wednesday 22 April 2020

Article
SUMMARY

Antipsychotic and sedative medication use in long-term care facilities providing dementia care

Etuini Ma’u, Janine Burton, Elizabeth Fussell

This study aimed to quantify the use of antipsychotic and sedative medications in residents with dementia in long-term care facilities in the Waikato and identify factors associated with the prescription of these medications. Despite the increasing evidence around the relatively poor efficacy and increased risks associated with antipsychotic and sedative prescription in individuals with dementia, this study shows the use of these medications in dementia care and psychogeriatric facilities remains high, with 48.2% of residents in this study currently prescribed an antipsychotic and 22.1% prescribed a sedative. Furthermore, less than 20% of those prescribed an antipsychotic or a sedative had the most recent dose change occur within the 12 weeks recommended by guidelines, with over 30% of those prescribed an antipsychotic and 48% of those prescribed a sedative not having their dose adjusted for over a year. With clear evidence of the risks of antipsychotics in dementia, the proportion of residents prescribed an antipsychotic or sedative in this study, in conjunction with the prolonged duration of prescription, is cause for concern and needs addressing.

Article
SUMMARY

Does research help to inform a district health board’s purpose? A qualitative thematic analysis of clinician researcher views

Lorraine Neave, Duncan Reid, Brian McKenna

This study explored, from a district health board (DHB) staff perspective, what the enablers and barriers to doing research were and whether the outcomes of research activity helped it deliver best care. It has provided insight into how organisational factors can negatively influence engagement in and with research and thereby impact the potential for research to inform the DHB’s overarching purpose. These factors are all modifiable influences. The themes offer a direction for the DHB’s future research strategy, where research activity is integrated into practice, where research evidence is discussed and where research achievements are celebrated. The findings from this study will likely resonate across New Zealand’s DHB landscape.

Article
SUMMARY

How common are non-acute coronary syndrome (ACS) diagnoses in patients with suspected ACS investigated with coronary angiography in New Zealand? (ANZACS-QI 58)

Charles Yao-Cheng Ho, Mildred Lee, Seif El-Jack, Peter Barr, Mark Simmonds, Gerry Devlin, Philip D Adamson, Michael Williams, Andrew J Kerr

Falsely activated coronary catheter laboratories for acute ST elevation heart attacks are low in New Zealand. Non-ACS conditions receiving invasive coronary angiography varies between DHBs requires more investigation.

Article
SUMMARY

Social impacts and costs of schizophrenia: a national cohort study using New Zealand linked administrative data

Sheree Gibb, Naomi Brewer, Nicholas Bowden

We used data for the whole New Zealand population to compare people diagnosed with schizophrenia to similar people without schizophrenia. Compared to people without schizophrenia, people with schizophrenia experienced more adverse outcomes, including: unemployment; lower income; contact with the criminal justice system; and hospitalisation (for both mental and physical health reasons). The government costs (money spent by the New Zealand government on people’s social, health and other services) were six times higher for people living with schizophrenia than for people without schizophrenia. The biggest cost differences were in healthcare, benefits and social housing.

Article
SUMMARY

Spatial, temporal and socioeconomic patterns of illicit drug use in New Zealand assessed using wastewater-based epidemiology timed to coincide with the census

Mackay Price, Chris Wilkins, Benjamin J Tscharke, Tom Baker, Jochen F Mueller, Sam Trowsdale

Wastewater samples were collected across seven sites in three regions of New Zealand to coincide with the 2018 census. This provided a way to quantify drug use and sociodemographics and assess the accuracy of drug survey techniques. The data show the expected regional, sub-regional and temporal patterns of illicit drug use, such as more MDMA consumed on the weekends than during the week. The key take home messages is that, in combination with complementary data like censuses, surveys and seizure information, wastewater analysis can help guide harm reduction policy for the wellbeing of New Zealand.

Article
SUMMARY

Reducing the MRI outpatient waiting list through a capacity and demand time series improvement programme

Heera Bhullar, Bernadette County, Stuart Barnard, Anne Anderson, Mary E Seddon

A partnership between Ko Awatea and the radiology department at Counties Manukau District Health Board aimed to match the demand for magnetic resonance imaging (MRI) with the available capacity. Using quality improvement techniques, the team successfully and sustainably reduced the MRI waiting list over a two-year period, reducing the number of patients waiting from nearly 2,000 to just over 400. The innovative solutions to segment the waiting list and match capacity to demand may be instructive for other radiology departments, and other waiting list scenarios.

Viewpoint
SUMMARY

Cannabis Legalisation and Control Bill: should doctors be concerned?

Guna Kanniah, Shailesh Kumar

The regulatory and policy changes about legalising cannabis correlate with heightened acceptance, reduced perception of risks and an increase in cannabis use in both adults and adolescents, and controlled access to cannabis can be associated with better outcomes. The evidence for use in treating psychiatric illnesses is still lacking, and people who at a greater risk of experiencing adverse mental health outcomes will still be vulnerable under the proposed legislation. Regular cannabis use predicts an increased risk of schizophrenia. Cannabis is known to disproportionately harm people who have either a risk of mental illnesses or have existing mental illness. This significant at-risk population will not be protected by the proposed legislation in its current form. Data from other countries showing the beneficial effects of cannabis use in psychiatric populations are limited and conflicting, and potential harms in patients with psychotic and mood disorders have been increasingly documented. Further high-quality studies examining the effect of cannabis/cannabinoids on mental disorders are needed before any such policy changes.

Clinical Correspondence
SUMMARY

Zoledronate-induced anterior uveitis, scleritis and optic neuritis: a case report

Laura E Wolpert, Andrew R Watts

Zoledronate, a bisphosphonate medication used to treat osteoporosis, can cause inflammation of different parts of the eye. Inflammation of the iris, known as anterior uveitis, happens in about 1% of people treated with bisphosphonates. This paper describes a case of a female patient who developed inflammation of the iris, the sclera (the white of the eye) and the optic nerve following treatment with zoledronate.

Letter
SUMMARY

The competition is next door! Why a voluntary approach to tobacco retailer reduction will never work

Richard Portch

This paper describes the distribution of tobacco retailers across Tamaki Mākaurau and compares them with community pharmacies. We used a new methodology for attributing the deprivation and demographics of neighbourhood surrounding each retailer. Our research identified significant differences in how tobacco retailers and community pharmacies are distributed across the region, including that tobacco retailers are more likely to be in residential areas than community pharmacies and are more likely to have another tobacco retailer in close proximity to their location.

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