Vol 134 No 1542: 17 September 2021

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Issue Summary

Article

SUMMARY

Pre-hospital delays in patients experiencing symptoms of acute stroke or transient ischaemic attack

Karim M Mahawish, Daniel Greenblatt

In our study, knowledge of stroke symptoms was good, but only half of patients thought of stroke as a medical emergency and arrived at hospital early enough to be eligible for specialised emergency treatment. Reasons for delay included not appreciating the significance of their symptoms, transport challenges, or not wanting to be a burden on others or the healthcare system. Patients who called 111 soon after the stroke symptoms started were more likely to receive clot busting medication, meaning a greater chance of recovery. Sudden face/arm weakness or speech disturbance (ie, FAST positive) could indicate a medical emergency. Immediately calling 111 offers the best chance of reducing long term disability.

Article

SUMMARY

Venovenous extracorporeal membrane oxygenation for treating very severe pneumonia in Aotearoa New Zealand: a 16-year experience

André Kübler, Fynn Maguire, David Sidebotham

Extracorporeal membrane oxygenation (ECMO) is a potentially lifesaving treatment for patients with very severe pneumonia who are failing conventional intensive therapies. The Cardiothoracic and Vascular Intensive Care Unit at Auckland City Hospital is a national referral centre for adult ECMO for Aotearoa New Zealand. Over the last 16 years, we have used ECMO for over 130 patients in Aotearoa New Zealand with very severe pneumonia and our outcomes are comparable to large overseas units. Our use of ECMO is broadly in keeping with the geographic and ethnic distribution of the population of Aotearoa New Zealand. However, because Māori and Pacific Peoples have higher rates of pneumonia with more aggressive microorganisms than other New Zealanders (up to three times higher), it is possible that Māori and Pacific Peoples have less access to this potentially lifesaving intervention than other New Zealanders.

Article

SUMMARY

Clinical and epidemiological characteristics of COVID-19 in Wellington, New Zealand: a retrospective, observational study | OPEN ACCESS

Nethmi Kearns, Allie Eathorne, Tessa Luff, Ciléin Kearns, Craig Thornley, Alex Semprini, Richard Beasley, Annette Nesdale

This study looked at the characteristics of COVID-19 cases in the Wellington region during the first wave (1 January 2020 to 1 August 2020). There were 96 cases of COVID-19 with most of them being of European ethnicity and from a high socioeconomic background. The majority of the cases in Wellington were related to travel and seen in those coming into Aotearoa New Zealand from overseas. This study showed that there was no set of “classic” symptoms that could accurately predict infection, and that individuals with COVID-19 had a variety of different symptoms from cough to tummy pain. With New Zealanders following the Alert Level guidelines and other public health advice in 2020, we managed to keep transmission within communities to a minimum and protect the vulnerable.

Article

SUMMARY

Disparities in post-operative mortality between Māori and non-Indigenous ethnic groups in New Zealand | OPEN ACCESS

Jason Gurney, Melissa McLeod, James Stanley, Diana Sarfati, Doug Campbell, Cheryl Davies, Elizabeth Dennett, Peter Himona, Sarah Jackson, Dick Ongley, Bridget Robson, Juliet Rumball-Smith, Virginia Signal, Jeannine Stairmand, Courtney Thomas, Jonathan Koea

In this study, we looked at nearly 4 million surgical procedures that took place within hospitals around New Zealand between 2005 and 2017. We found that Māori patients (in particular) are more likely to die within 30 days of a procedure compared to European patients. This is probably because of unfair differences in access to the best care when it is needed the most. We believe that we need to pay more attention in the future to how well Māori are accessing surgical care, including “pre-operative” care.

Article

SUMMARY

A decade of Asian and ethnic minority health research in New Zealand: findings from a scoping review

Annie Chiang, Rachel Simon-Kumar, Roshini Peiris-John

Health research on Asians and other ethnic minority groups in New Zealand is extremely limited. A study of peer-reviewed publications in national and international academic journals identified a total of 115 articles from 2010–2019, a period in which minority ethnic populations in the country grew from 12% to 18%. Of these published studies, the majority focused on the Indian and Chinese populations, whereas there was virtually little research done on smaller demographic groups: for instance, publications on New Zealand’s African populations totalled eight, and Sri Lankan, Middle-Eastern and Latin American groups had fewer than five studies each to report. The study also identified a concentration of research in two key areas, cardiovascular diseases and vitamin deficiencies, and demonstrated a glaring gap in evidence across a broader range of diseases and their treatment and management. There is also little research that focuses on the experiences of these groups within New Zealand’s health system. Among the suggestions to improve health scholarship for these populations include: better prioritisation of Asian and ethnic minority health in research; the targeted availability of resources such as research grants to undertake research on this population group; better support and systems that enable the conversion of research into publications; and urgent improvements in the training, recruitment and retention of Asian and minority ethnic researchers in New Zealand universities and health research agencies.

Article

SUMMARY

Ultrasound use in suspected testicular torsion: an association with delay to theatre and increased intraoperative finding of non-viable testicle

Hannah Grace Wright, Hamish John Wright

This ten-year review of testicular torsion cases presenting to Auckland City Hospital from 2007–2017 comprises the largest contemporary Australasian review of testicular torsion. It has the notable findings of ultrasound use being associated with a two-hour delay to the operating theatre and a four-fold increase in intraoperative finding of non-viable testicle. These findings support the notion that ultrasound should not be used in cases where testicular torsion is suspected if it causes a delay in operative management.

Viewpoint

SUMMARY

Chimeric antigen receptor T-cells in New Zealand: challenges and opportunities

Robert Weinkove, Philip George, Myra Ruka, Tia Huia Haira, Giulia Giunti

CAR T-cell therapy is an emerging form of immunotherapy that works by redirecting a patient’s T-cells to recognise and destroy cancer. As a one-off treatment, CAR T-cell therapy can cure some types of blood cancer. New Zealand’s first CAR T-cell trial, ENABLE, has involved local manufacture and delivery of CAR T-cells to patients and demonstrates the feasibility of this type of treatment in Aotearoa New Zealand. Māori involvement and consultation will be key to assuring equity of access to CAR T-cell therapies. We believe that Aotearoa New Zealand is in an excellent position to develop and implement this exciting treatment in the future.

Editorial