Issue

Vol 134 No 1539: 30 July 2021

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Issue Summary

Viewpoint
SUMMARY

Frailty should be assessed in older patients considered for colonoscopy

Tyson A Oberndorfer, Ricardo Jurawan

Older people who get a colonoscopy tend to have more complications because they are more frail. Frailty is a medical condition characterized by weakness, decreased function and increased vulnerability to bad outcomes from stressful events like a colonoscopy. Frailty has already been shown to predict bad outcomes from surgery, but not much research has been done on frailty predicting outcomes from colonoscopy. We recommend that doctors who perform colonoscopies assess their patients for frailty and use that information to discuss with patients the benefits and risks of going ahead with the colonoscopy.

Article
SUMMARY

Impact of pharmacist involvement on medication safety in interprofessional transfer of care activity

Claire Dillon, Georgina Lynch, John Dean, Caralyn Purvis, Lutz Beckert

Medication errors are a huge problem for patients causing real and potential harm. It’s difficult to reduce these—the World Health Organization has made some suggestions. Interprofessional education is beneficial and was used as the backdrop for the current study. This paper examined whether the presence of a in-person pharmacist (not just detailed pharmacist notes) reduced errors (it didn’t) or severity of errors (it did), and we also demonstrated much-improved communication to the community team with the pharmacist in person. We would anticipate less medication-related harm to a patient post discharge, with reduced readmissions and subsequent reduced costs to the health system.

Article
SUMMARY

Health professionals’ self-identified knowledge, barriers and educational needs regarding identification and management of adolescent and young adult cancer in New Zealand

Dong Hyun Kim, Rochelle Moss, Claire Gooder, Grace Lee, Heidi Watson, Tristan Pettit

An adolescents and young adults (AYA) cancer diagnosis is rare, with an average of 190 new cases each year representing less than 1% of all new cancer diagnoses in New Zealand. Often young people present with vague symptoms that primary healthcare professionals can attribute to AYA age and stage. It is theorised that survival disparities that exist in the AYA age group may be impacted by delays in diagnosis. A survey of over 200 young people with cancer conducted in 2018 by the AYA cancer network identified 35% of young people visited a GP at least 3 times before referral to a specialist. The paper explored knowledge and educational needs of primary health care professionals regarding identification and referral of AYA with suspected cancer in New Zealand. The findings concluded a significant self-identified knowledge gap for primary health care professionals related to AYA cancer symptoms and knowledge of diagnostic pathways. Time is identified as a significant barrier to both diagnosis (ability to explore vague symptoms) and professional development regarding AYA cancer. Primary health care providers are receptive to professional AYA cancer education and their preference is for online provision.

Article
SUMMARY

Outcomes following open radical cystectomy: an 11-year Christchurch experience

Jeremy Wild, Andrea Cross, Peter Davidson, Chris Frampton

Radical cystectomy (RC) remains the standard approach to treating muscle invasive bladder cancer. A retrospective review of all patients who underwent RC at Christchurch Hospital, New Zealand, between January 2007 and January 2018 was undertaken. Data on demographic, operative and post-operative variables were collected. 30- and 90-day mortality rates were assessed along with five-year survival. There were low rates of neo-adjuvant (11%) and adjuvant (5%) chemotherapy use. The median length of stay was 10 days (6–44 days) and 23 patients (17%) had a Clavien-Dindo grade 3 or above complication. Thirty- and 90-day mortality was 2.2% and 4.4% respectively. Five-year overall and disease-specific survival rates were 49.7% and 59.3% respectively. American Joint Committee on Cancer (AJCC) stage was a positive predictor of overall survival, with the risk of death increasing incrementally for each progression of stage. The perioperative outcomes observed in this study were comparable to other published series. The subsequent development of metastatic disease remains a problem, with poor five-year survival rates.

Article
SUMMARY

How has contraceptive provision at Family Planning clinics in Aotearoa New Zealand changed between 2009, 2014 and 2019: a cross-sectional analysis | OPEN ACCESS

Beth Messenger, Amy Beliveau, Mike Clark, Caroline Fyfe, Alison Green

This research investigates changes in what contraceptives Family Planning clients chose to use in 2009, 2014 and 2019. The research found that clients in 2019 were more likely to use long-acting reversible contraceptives (eg, an implant or Mirena) than short-acting reversible contraceptives (eg, the pill or Depo Provera) as compared to 2009. The research found that if a contraceptive were free, clients would be more likely to choose it, but also, that there would be differences in what contraceptives were chosen based on ethnic group and poverty level that did not relate to whether the contraceptive was free or not. We need more information about what contraceptives people choose to use, and why, so we can make sure everyone can access what is best for them.

Article
SUMMARY

Four years of prevocational Community Based Attachments in New Zealand: a review

Wayne de Beer, Helen Clark

Four years after community-based attachments (CBA) were started in New Zealand, we looked at some regional results. The learning environment of CBAs is perceived by prevocational doctors as valuable. The New Zealand Medical Council’s decision to incorporate a period of training in community settings has been well reserved by prevocational doctors.

Article
SUMMARY

An evaluation of diagnostic tests in a case series of suspected leptospirosis patients seen in primary care

Lynsey Earl, Fang Fang, Ron Janes, Kristene Gedye, Nigel French, Julie Collins-Emerson, Jackie Benschop

Leptospirosis is an important occupational illness for rural New Zealanders. People get infected through contact with infected animal urine or contaminated water. Leptospirosis often looks like the flu and as a result is often not tested for or even suspected. A positive test diagnosis is required for to receive ACC compensation for time off work. A positive test also gives patients and their doctors peace of mind and an understanding that recovery may be prolonged, and it raises awareness and provides an opportunity to start preventative measures, such as rodent control or livestock vaccination. We found that no one test will consistently diagnose all infected patients. To increase the likelihood of diagnosis, doctors need to order multiple tests.

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SUMMARY
Editorial
Vol 134 No 1539: 30 July 2021

Mānawatia a Matariki!

Suzanne Pitama, Cameron Lacey, Tania Huria, Janak de Zoysa, David McBride, Roger Mulder, Kiki Maoate, Mark Weatherall, Frank Frizelle.

When Matariki, a star cluster, rises in Aotearoa’s north-eastern skies, it marks the start of the Māori new year. With an end of one year and the birth of another comes a time to reflect on the past and plan together for the future.

Article
Vol 134 No 1539: 30 July 2021

Impact of pharmacist involvement on medication safety in interprofessional transfer of care activity

Claire Dillon, Georgina Lynch, John Dean, Caralyn Purvis, Lutz Beckert

Up to 97% of patients have medication transcription errors on admission to hospital, and almost 80% of patients will have at least one discrepancy on discharge.

Article
Vol 134 No 1539: 30 July 2021

Health professionals’ self-identified knowledge, barriers and educational needs regarding identification and management of adolescent and young adult cancer in New Zealand

Dong Hyun Kim, Rochelle Moss, Claire Gooder, Grace Lee, Heidi Watson, Tristan Pettit

New Zealand’s adolescent and young adult (AYA) cancer population represents those diagnosed between 12 and 24 years of age. Due to their different age-related medical and psychosocial healthcare needs, AYAs are a specialised cohort compared with paediatric or adult cancer patients.

Article
Vol 134 No 1539: 30 July 2021

Outcomes following open radical cystectomy: an 11-year Christchurch experience

Jeremy Wild, Andrea Cross, Peter Davidson, Chris Frampton

Radical cystectomy (RC) remains a primary approach to treating muscle invasive bladder cancer (MIBC) as well as recurrent high-grade non-muscle invasive bladder cancer (NMIBC).

Article
Vol 134 No 1539: 30 July 2021

How has contraceptive provision at Family Planning clinics in Aotearoa New Zealand changed between 2009, 2014 and 2019: a cross-sectional analysis | OPEN ACCESS

Beth Messenger, Amy Beliveau, Mike Clark, Caroline Fyfe, Alison Green

Advances in contraception are recognised as one of the great public health achievements of the twentieth century.

Article
Vol 134 No 1539: 30 July 2021

Four years of prevocational Community Based Attachments in New Zealand: a review

Wayne de Beer, Helen Clark

The New Zealand Curriculum Framework for Prevocational Medical Training (NZCF) 2014 outlines the intern training programme that involves two years of training following graduation from medical school.

Article
Vol 134 No 1539: 30 July 2021

An evaluation of diagnostic tests in a case series of suspected leptospirosis patients seen in primary care

Lynsey Earl, Fang Fang, Ron Janes, Kristene Gedye, Nigel French, Julie Collins-Emerson, Jackie Benschop

New Zealand has one of the highest incidences of leptospirosis among countries with a temperate climate.

Viewpoint
Vol 134 No 1539: 30 July 2021

Frailty should be assessed in older patients considered for colonoscopy

Tyson A Oberndorfer, Ricardo Jurawan

The United States Preventive Services Task Force recommends an upper age limit of 75 for asymptomatic colorectal cancer (CRC) screening, primarily because of the likely benefit of early detection in a patient population with limited life expectancy.

Clinical Correspondence
Vol 134 No 1539: 30 July 2021

Multiple cranial neuropathies as the initial presentation of EBV-positive diffuse large B-cell lymphoma

Gisela A Kristono, Lara Benoiton, Sean Lance, Katherine Baguley, Michelle Dickson, Duncan Smyth, Satish Hulikunte

Diffuse large B-cell lymphoma (DLBCL) is the most common type of aggressive lymphoma in adults.

100 Years Ago in the NZMJ
Vol 134 No 1539: 30 July 2021

Chronic Tubal Nephritis

NZMJ

In the Last October number of the New Zealand Medical Journal I related a case of chronic tubal nephritis which had been greatly relieved or possibly cured by a 29 days’ “fast” with colonic irrigation, etc.

Erratum
Vol 134 No 1539: 30 July 2021

Erratum

NZMJ

Proceedings
Vol 134 No 1539: 30 July 2021

Brain Research New Zealand – Rangahau Roro Aotearoa, April 2021 conference abstracts

Article
SUMMARY

Impact of pharmacist involvement on medication safety in interprofessional transfer of care activity

Claire Dillon, Georgina Lynch, John Dean, Caralyn Purvis, Lutz Beckert

Medication errors are a huge problem for patients causing real and potential harm. It’s difficult to reduce these—the World Health Organization has made some suggestions. Interprofessional education is beneficial and was used as the backdrop for the current study. This paper examined whether the presence of a in-person pharmacist (not just detailed pharmacist notes) reduced errors (it didn’t) or severity of errors (it did), and we also demonstrated much-improved communication to the community team with the pharmacist in person. We would anticipate less medication-related harm to a patient post discharge, with reduced readmissions and subsequent reduced costs to the health system.

Article
SUMMARY

Health professionals’ self-identified knowledge, barriers and educational needs regarding identification and management of adolescent and young adult cancer in New Zealand

Dong Hyun Kim, Rochelle Moss, Claire Gooder, Grace Lee, Heidi Watson, Tristan Pettit

An adolescents and young adults (AYA) cancer diagnosis is rare, with an average of 190 new cases each year representing less than 1% of all new cancer diagnoses in New Zealand. Often young people present with vague symptoms that primary healthcare professionals can attribute to AYA age and stage. It is theorised that survival disparities that exist in the AYA age group may be impacted by delays in diagnosis. A survey of over 200 young people with cancer conducted in 2018 by the AYA cancer network identified 35% of young people visited a GP at least 3 times before referral to a specialist. The paper explored knowledge and educational needs of primary health care professionals regarding identification and referral of AYA with suspected cancer in New Zealand. The findings concluded a significant self-identified knowledge gap for primary health care professionals related to AYA cancer symptoms and knowledge of diagnostic pathways. Time is identified as a significant barrier to both diagnosis (ability to explore vague symptoms) and professional development regarding AYA cancer. Primary health care providers are receptive to professional AYA cancer education and their preference is for online provision.

Article
SUMMARY

Outcomes following open radical cystectomy: an 11-year Christchurch experience

Jeremy Wild, Andrea Cross, Peter Davidson, Chris Frampton

Radical cystectomy (RC) remains the standard approach to treating muscle invasive bladder cancer. A retrospective review of all patients who underwent RC at Christchurch Hospital, New Zealand, between January 2007 and January 2018 was undertaken. Data on demographic, operative and post-operative variables were collected. 30- and 90-day mortality rates were assessed along with five-year survival. There were low rates of neo-adjuvant (11%) and adjuvant (5%) chemotherapy use. The median length of stay was 10 days (6–44 days) and 23 patients (17%) had a Clavien-Dindo grade 3 or above complication. Thirty- and 90-day mortality was 2.2% and 4.4% respectively. Five-year overall and disease-specific survival rates were 49.7% and 59.3% respectively. American Joint Committee on Cancer (AJCC) stage was a positive predictor of overall survival, with the risk of death increasing incrementally for each progression of stage. The perioperative outcomes observed in this study were comparable to other published series. The subsequent development of metastatic disease remains a problem, with poor five-year survival rates.

Article
SUMMARY

How has contraceptive provision at Family Planning clinics in Aotearoa New Zealand changed between 2009, 2014 and 2019: a cross-sectional analysis | OPEN ACCESS

Beth Messenger, Amy Beliveau, Mike Clark, Caroline Fyfe, Alison Green

This research investigates changes in what contraceptives Family Planning clients chose to use in 2009, 2014 and 2019. The research found that clients in 2019 were more likely to use long-acting reversible contraceptives (eg, an implant or Mirena) than short-acting reversible contraceptives (eg, the pill or Depo Provera) as compared to 2009. The research found that if a contraceptive were free, clients would be more likely to choose it, but also, that there would be differences in what contraceptives were chosen based on ethnic group and poverty level that did not relate to whether the contraceptive was free or not. We need more information about what contraceptives people choose to use, and why, so we can make sure everyone can access what is best for them.

Article
SUMMARY

Four years of prevocational Community Based Attachments in New Zealand: a review

Wayne de Beer, Helen Clark

Four years after community-based attachments (CBA) were started in New Zealand, we looked at some regional results. The learning environment of CBAs is perceived by prevocational doctors as valuable. The New Zealand Medical Council’s decision to incorporate a period of training in community settings has been well reserved by prevocational doctors.

Article
SUMMARY

An evaluation of diagnostic tests in a case series of suspected leptospirosis patients seen in primary care

Lynsey Earl, Fang Fang, Ron Janes, Kristene Gedye, Nigel French, Julie Collins-Emerson, Jackie Benschop

Leptospirosis is an important occupational illness for rural New Zealanders. People get infected through contact with infected animal urine or contaminated water. Leptospirosis often looks like the flu and as a result is often not tested for or even suspected. A positive test diagnosis is required for to receive ACC compensation for time off work. A positive test also gives patients and their doctors peace of mind and an understanding that recovery may be prolonged, and it raises awareness and provides an opportunity to start preventative measures, such as rodent control or livestock vaccination. We found that no one test will consistently diagnose all infected patients. To increase the likelihood of diagnosis, doctors need to order multiple tests.

Viewpoint
SUMMARY

Frailty should be assessed in older patients considered for colonoscopy

Tyson A Oberndorfer, Ricardo Jurawan

Older people who get a colonoscopy tend to have more complications because they are more frail. Frailty is a medical condition characterized by weakness, decreased function and increased vulnerability to bad outcomes from stressful events like a colonoscopy. Frailty has already been shown to predict bad outcomes from surgery, but not much research has been done on frailty predicting outcomes from colonoscopy. We recommend that doctors who perform colonoscopies assess their patients for frailty and use that information to discuss with patients the benefits and risks of going ahead with the colonoscopy.

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