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Issue

Vol 135 No 1555: 20 May 2022

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Issue Summary

SUMMARY

Adherence to a national consensus statement on informed consent: medical students’ experience of obtaining informed consent from patients for sensitive examinations

Harsh Bhoopatkar, Carlos F C Campos, Phillipa J Malpas, Andy M Wearn

Many medical students in the study performed sensitive examinations (breast, rectal, genital, and female vaginal/pelvic examinations) without following the guidance from the New Zealand national consensus statement for obtaining informed consent (the process of talking that leads to agreement or permission) from patients. There are many factors related to students, supervisors, and the medical school that are reasons why these guidelines were not followed. We need to review these findings to ensure a safe learning environment for patients and our students.

Article
SUMMARY

Ethnic disparity in clozapine dosing and cardiotoxicity in New Zealand

Kathryn E Burns, Brandi L Bellissima, Fintan Garavan, Nuala A Helsby, Malcolm D Tingle

Clozapine is an important medication used in patients with treatment-resistant schizophrenia. Although it is very effective in comparison to other drugs, its can cause serious side effects in patients including damage to their heart (myocarditis and/or cardiomyopathy). In this study we have shown that Māori patients are more likely to develop this heart damage than other New Zealanders. We also found that Māori and Pacific patients tend to be given a higher dose of clozapine than other patients, and Māori are also more likely to be prescribed sodium valproate alongside clozapine, both of which are known risk factors for the development of clozapine-induced myocarditis.

Article
SUMMARY

Spontaneous coronary artery dissection: insights from computed tomography coronary angiography follow-up

Bernard Wong, Andrew To, Seif El-Jack

Spontaneous coronary artery dissection (SCAD) is a spontaneous tear in the wall of the blood vessels of the heart. It is an important cause of heart attacks, especially in younger to middle aged women. Computed tomography coronary angiography (CTCA) is a scan of the heart vessels which is useful to follow-up patients with SCAD without further need for invasive procedures. It is useful to show healing of the vessel, particularly if performed after 80 days from the heart attack.

Article
SUMMARY

The effect of rurality and ethnicity in patients with acute cholecystitis in Northland, New Zealand

Niki Kau, Matthew McGuinness, Peter Swan, Christopher Harmston

This study found similar clinical severity, management and outcomes in patients with acute cholecystitis, comparing rural and urban patients. Māori patients presented at a significantly younger age.

Article
SUMMARY

Describing the experience of Indigenous peoples with prenatal alcohol exposure and FASD: a global review of the literature to inform a Kaupapa Māori study into the experiences of Māori with FASD

Emma Espiner, Freeman Apou, Elizabeth Strickett, Andi Crawford, Maria Ngawati

Our findings emphasise the importance of deep community connections between researchers and participants, Indigenous leadership of research projects and a focus on strength-based approaches with an appreciation of the social determinants of health issues in global research into the experience of Indigenous peoples with prenatal alcohol exposure and FASD. This research is consistent with global research into the most effective health interventions for Indigenous communities.

Viewpoint
SUMMARY

Low but increasing rates of inflammatory bowel disease in Māori: a report from Lakes District Health Board IBD

Mandy Qiu, Rajan N Patel, Clarence Kerrison, Richard B Gearry

We aimed to find out how common inflammatory bowel disease is in the Lakes DHB. We counted the cases from a number of sources and compared the cases. The rates were lower in Māori than non-Māori but the rates are the highest ever described for Māori and are increasing in recent years. Causes for the different rates are not clear from this research.

Article
SUMMARY

Cholesterol treatment in patients with acute coronary syndromes: does stating a target improve management?

Andrew Borrie, Emily Fiennes, Scott A Harding, Alexander Sasse

Guidelines recommend patients who have a heart attack should have LDL cholesterol treated to reach a target of less than 1.8mmol/L. We have shown that medications to reduce cholesterol are frequently prescribed but testing and uptitration is less consistent. A change in practice stating cholesterol targets on discharge summary paperwork increased cholesterol testing and medication uptitration, resulting in more patients reaching target LDL-C (64% vs 47%, P=0.02).

Clinical Correspondence
SUMMARY

A case of segmental arterial mediolysis: a vasculitis mimic

Gursimran Kaur, Timothy Buckenham, Timothy Beresford, Peter Chapman

We present a case of segmental arterial mediolysis (SAM) in a 40-year-old female dairy farmer. SAM is a rare but increasingly recognised and potentially severe type of vascular disease with reported high mortality rates. As it is a potentially life-threatening disease that can mimic other conditions for which the treatment greatly differs, awareness amongst vascular and general surgeons as well as rheumatologists and immunologists is relevant.

Clinical Correspondence
SUMMARY

An open surgical approach to facilitate endovascular thrombectomy for acute stroke: how vascular surgery can play a role

Eric T A Lim, Teddy Y Wu, Andrew D P Laing, Adib Mohamad Ali Khanafer

Stroke is commonly treated nowadays using a minimally invasive procedure to remove the blood clot in the brain. This case reports on the challenges faced with this procedure when there is a blood clot in the carotid artery preventing access into the arteries within the brain. We discuss the use of an open surgical approach to facilitate this procedure in a patient presenting with acute stroke.

Article
SUMMARY

Ethnic differences in those presenting for outpatient management of venous leg ulcers

Samuel Blackmore, Alice Bourke, Peter Wash, Natalie Scott, Timothy Blackmore

Venous leg ulcers are a type of wound resulting from skin break down after minor injury in the setting of poor venous blood flow. They often become chronic, and are unlikely to heal without nursing intervention and spending time with the legs elevated. Those affected have major reduction on their quality of life, and this study shows that Maori and Pasifika are disproportionately affected. This study was not designed to find the causes of venous leg ulcers in different populations, but shows the extent of the problem and should lead to further study into how best to them.

ALL ARTICLES
SUMMARY
Editorial
Vol 135 No 1555: 20 May 2022

From here to where: the continued metamorphosis of the NZMJ

Frank Frizelle

Most of us are resistant to change as it requires some effort to adjust, and at times it feels uncomfortable. What we are familiar with is predictable and frequently reliable enough. Change challenges us and forces us to reassess what we think of as important. Change, however, is inevitable, and is the only way to see improvement.

Vol 135 No 1555: 20 May 2022

Adherence to a national consensus statement on informed consent: medical students’ experience of obtaining informed consent from patients for sensitive examinations

Harsh Bhoopatkar, Carlos F C Campos, Phillipa J Malpas, Andy M Wearn

One of the challenges specific to teaching and learning sensitive examinations involves the conflict between ethical and educational needs. Balancing the educational needs of students to learn sensitive examinations on real patients and the vulnerability of these patients raises an ethical dilemma.

Article
Vol 135 No 1555: 20 May 2022

Determinants of exclusive breastfeeding for wāhine Māori

Denise Bennett, Catherine A Gilchrist, Rochelle L Menzies, Matire Harwood, Te Kani Kingi, Polly Atatoa Carr, Susan Morton, Cameron C Grant

Māori mothers have the right to breastfeed their infants. This is recognised in the United Nations (UN) Convention on the Rights of the Child, and the right to traditional practices in the UN Declaration on the Rights of Indigenous Peoples and the Treaty of Waitangi. For Māori, tamariki (children) are taonga (treasured), and breastfeeding is tika tūāpapa (a fundamental right). Within Te Ao Māori (Māori worldview), breastfeeding is a fundamental aspect of tikanga Māori (Māori cultural traditions/practices) that needs to be protected and promoted.

Article
Vol 135 No 1555: 20 May 2022

Ethnic disparity in clozapine dosing and cardiotoxicity in New Zealand

Kathryn E Burns, Brandi L Bellissima, Fintan Garavan, Nuala A Helsby, Malcolm D Tingle

The reported incidence of these cardiotoxicities is higher in Australia and New Zealand than in other countries. Three independent studies of Australian populations have reported treatment-limiting or fatal cardiotoxicities in 2.4–8.5% of clozapine patients, and our group has recently demonstrated incidences of clozapine-induced myocarditis and cardiomyopathy in the Auckland District Health Board (ADHB) of 3.8% and 1.3%, respectively. During that analysis it was noted that, although the numbers were small, patients of Māori descent appeared to be overrepresented in the myocarditis cases.

Article
Vol 135 No 1555: 20 May 2022

Spontaneous coronary artery dissection: insights from computed tomography coronary angiography follow-up

Bernard Wong, Andrew To, Seif El-Jack

Spontaneous coronary artery dissection (SCAD) is a separation of the coronary arterial wall that is not associated with trauma or iatrogenic causes. It is an underdiagnosed cause of acute myocardial infarction commonly affecting young to middle aged women, often without classic cardiovascular risk factors.

Article
Vol 135 No 1555: 20 May 2022

The effect of rurality and ethnicity in patients with acute cholecystitis in Northland, New Zealand

Niki Kau, Matthew McGuinness, Peter Swan, Christopher Harmston

Acute cholecystitis is the most common emergency consequence of gallstones and is a common reason for emergency admission in general surgery internationally and in New Zealand.

Article
Vol 135 No 1555: 20 May 2022

Describing the experience of Indigenous peoples with prenatal alcohol exposure and FASD: a global review of the literature to inform a Kaupapa Māori study into the experiences of Māori with FASD

Emma Espiner, Freeman Apou, Elizabeth Strickett, Andi Crawford, Maria Ngawati

Foetal Alcohol Spectrum Disorder (FASD) is one of the key causes of developmental disability, and is characterised by severe neurological impairments that significantly impact general health and wellbeing.

Article
Vol 135 No 1555: 20 May 2022

Cholesterol treatment in patients with acute coronary syndromes: does stating a target improve management?

Andrew Borrie, Emily Fiennes, Scott A Harding, Alexander Sasse

Cardiovascular disease is the most common cause of death in New Zealand, responsible for almost one in three deaths, with ischaemic heart disease alone causing approximately 4,800 deaths a year.

Article
Vol 135 No 1555: 20 May 2022

Ethnic differences in those presenting for outpatient management of venous leg ulcers

Samuel Blackmore, Alice Bourke, Peter Wash, Natalie Scott, Timothy Blackmore

Previous reviews by the Capital & Coast District Health Board District Nursing Service of venous leg ulcers have observed that Māori and Pasifika patients appear younger than those of other ethnicities. There are few published prevalence studies of VLU in New Zealand, and there are no published data from New Zealand on differences according to ethnicity.

Viewpoint
Vol 135 No 1555: 20 May 2022

Doctors’ travel in the Anthropocene

Aqeeda Singh, Jay Hadfield, Jesse Gale, Caroline Shaw

Climate change is now a global emergency, a red alert for humanity. Increased global temperatures are already resulting in dangerous storms, fires, heat waves and droughts. Transformative change is needed in every sector of every country to adapt to change that is already occurring and to prevent it getting worse.

Viewpoint
Vol 135 No 1555: 20 May 2022

The 1985 O’Regan report and a history of Otago Medical School’s admissions processes for Māori students

Indira Fernando, Peter Crampton

Policies for selection and admission to Otago Medical School have changed considerably over the past 50 years and are the subject of ongoing debate. In 2020, there was media coverage of the University’s attempts to introduce a cap to the current affirmative pathway for Māori students.

Viewpoint
Vol 135 No 1555: 20 May 2022

Low but increasing rates of inflammatory bowel disease in Māori: a report from Lakes District Health Board IBD

Mandy Qiu, Rajan N Patel, Clarence Kerrison, Richard B Gearry

Inflammatory bowel diseases (IBD) are chronic, inflammatory diseases comprising ulcerative colitis (UC) and Crohn’s disease (CD). New Zealand has one of the highest incidence rates of IBD worldwide, with an estimated 20,792 patients with IBD (1 in 227) increasing by 5.6% per year.

Clinical Correspondence
Vol 135 No 1555: 20 May 2022

A case of segmental arterial mediolysis: a vasculitis mimic

Gursimran Kaur, Timothy Buckenham, Timothy Beresford, Peter Chapman

Segmental arterial mediolysis (SAM) is a rare but increasingly recognised non-inflammatory, non-atherosclerotic and non-infectious vasculopathy of unknown aetiology that can potentially lead to life threatening manifestations. It involves disruption of the arterial medial layer causing dissection, aneurysm, occlusion or stenosis of abdominal arteries, with cases reported of coronary and intracranial vessel involvement.

Clinical Correspondence
Vol 135 No 1555: 20 May 2022

An open surgical approach to facilitate endovascular thrombectomy for acute stroke: how vascular surgery can play a role

Eric T A Lim, Teddy Y Wu, Andrew D P Laing, Adib Mohamad Ali Khanafer

Endovascular thrombectomy (EVT) is currently regarded as the gold standard of treatment in acute stroke. In this report, we describe an open surgical approach to treat an extracranial clot occlusion, which allowed for endovascular access to manage the intracranial occlusion.

Letter
Vol 135 No 1555: 20 May 2022

The incidence of diabetic ketoacidosis associated with empagliflozin use in Aotearoa New Zealand: a preliminary review

Lynne Chepulis, An Yu, Ryan Paul

Diabetic ketoacidosis (DKA) is a life-threatening but largely preventable complication of diabetes, resulting from excess ketone production due to relative or absolute insulin deficiency. DKA is primarily associated with type 1 diabetes mellitus (T1D), but may also occur in end-stage type 2 diabetes mellitus (T2D), and in those treated with sodium-glucose cotransporter-2 inhibitors (SGLT2).

100 Years Ago in the NZMJ
Vol 135 No 1555: 20 May 2022

Correspondence: Maternal Mortality [extract]

NZMJ

We are not going to get reform by abusing Health Authorities or the doctors, or the Monthly Nurses, but by coming one and all to the aid of the Health and Education Departments in a common effort to make maternity safe for the mother and safe for the child.

SUMMARY

Adherence to a national consensus statement on informed consent: medical students’ experience of obtaining informed consent from patients for sensitive examinations

Harsh Bhoopatkar, Carlos F C Campos, Phillipa J Malpas, Andy M Wearn

Many medical students in the study performed sensitive examinations (breast, rectal, genital, and female vaginal/pelvic examinations) without following the guidance from the New Zealand national consensus statement for obtaining informed consent (the process of talking that leads to agreement or permission) from patients. There are many factors related to students, supervisors, and the medical school that are reasons why these guidelines were not followed. We need to review these findings to ensure a safe learning environment for patients and our students.

Article
SUMMARY

Ethnic disparity in clozapine dosing and cardiotoxicity in New Zealand

Kathryn E Burns, Brandi L Bellissima, Fintan Garavan, Nuala A Helsby, Malcolm D Tingle

Clozapine is an important medication used in patients with treatment-resistant schizophrenia. Although it is very effective in comparison to other drugs, its can cause serious side effects in patients including damage to their heart (myocarditis and/or cardiomyopathy). In this study we have shown that Māori patients are more likely to develop this heart damage than other New Zealanders. We also found that Māori and Pacific patients tend to be given a higher dose of clozapine than other patients, and Māori are also more likely to be prescribed sodium valproate alongside clozapine, both of which are known risk factors for the development of clozapine-induced myocarditis.

Article
SUMMARY

Spontaneous coronary artery dissection: insights from computed tomography coronary angiography follow-up

Bernard Wong, Andrew To, Seif El-Jack

Spontaneous coronary artery dissection (SCAD) is a spontaneous tear in the wall of the blood vessels of the heart. It is an important cause of heart attacks, especially in younger to middle aged women. Computed tomography coronary angiography (CTCA) is a scan of the heart vessels which is useful to follow-up patients with SCAD without further need for invasive procedures. It is useful to show healing of the vessel, particularly if performed after 80 days from the heart attack.

Article
SUMMARY

The effect of rurality and ethnicity in patients with acute cholecystitis in Northland, New Zealand

Niki Kau, Matthew McGuinness, Peter Swan, Christopher Harmston

This study found similar clinical severity, management and outcomes in patients with acute cholecystitis, comparing rural and urban patients. Māori patients presented at a significantly younger age.

Article
SUMMARY

Describing the experience of Indigenous peoples with prenatal alcohol exposure and FASD: a global review of the literature to inform a Kaupapa Māori study into the experiences of Māori with FASD

Emma Espiner, Freeman Apou, Elizabeth Strickett, Andi Crawford, Maria Ngawati

Our findings emphasise the importance of deep community connections between researchers and participants, Indigenous leadership of research projects and a focus on strength-based approaches with an appreciation of the social determinants of health issues in global research into the experience of Indigenous peoples with prenatal alcohol exposure and FASD. This research is consistent with global research into the most effective health interventions for Indigenous communities.

Article
SUMMARY

Cholesterol treatment in patients with acute coronary syndromes: does stating a target improve management?

Andrew Borrie, Emily Fiennes, Scott A Harding, Alexander Sasse

Guidelines recommend patients who have a heart attack should have LDL cholesterol treated to reach a target of less than 1.8mmol/L. We have shown that medications to reduce cholesterol are frequently prescribed but testing and uptitration is less consistent. A change in practice stating cholesterol targets on discharge summary paperwork increased cholesterol testing and medication uptitration, resulting in more patients reaching target LDL-C (64% vs 47%, P=0.02).

Article
SUMMARY

Ethnic differences in those presenting for outpatient management of venous leg ulcers

Samuel Blackmore, Alice Bourke, Peter Wash, Natalie Scott, Timothy Blackmore

Venous leg ulcers are a type of wound resulting from skin break down after minor injury in the setting of poor venous blood flow. They often become chronic, and are unlikely to heal without nursing intervention and spending time with the legs elevated. Those affected have major reduction on their quality of life, and this study shows that Maori and Pasifika are disproportionately affected. This study was not designed to find the causes of venous leg ulcers in different populations, but shows the extent of the problem and should lead to further study into how best to them.

Viewpoint
SUMMARY

Low but increasing rates of inflammatory bowel disease in Māori: a report from Lakes District Health Board IBD

Mandy Qiu, Rajan N Patel, Clarence Kerrison, Richard B Gearry

We aimed to find out how common inflammatory bowel disease is in the Lakes DHB. We counted the cases from a number of sources and compared the cases. The rates were lower in Māori than non-Māori but the rates are the highest ever described for Māori and are increasing in recent years. Causes for the different rates are not clear from this research.

Clinical Correspondence
SUMMARY

A case of segmental arterial mediolysis: a vasculitis mimic

Gursimran Kaur, Timothy Buckenham, Timothy Beresford, Peter Chapman

We present a case of segmental arterial mediolysis (SAM) in a 40-year-old female dairy farmer. SAM is a rare but increasingly recognised and potentially severe type of vascular disease with reported high mortality rates. As it is a potentially life-threatening disease that can mimic other conditions for which the treatment greatly differs, awareness amongst vascular and general surgeons as well as rheumatologists and immunologists is relevant.

Clinical Correspondence
SUMMARY

An open surgical approach to facilitate endovascular thrombectomy for acute stroke: how vascular surgery can play a role

Eric T A Lim, Teddy Y Wu, Andrew D P Laing, Adib Mohamad Ali Khanafer

Stroke is commonly treated nowadays using a minimally invasive procedure to remove the blood clot in the brain. This case reports on the challenges faced with this procedure when there is a blood clot in the carotid artery preventing access into the arteries within the brain. We discuss the use of an open surgical approach to facilitate this procedure in a patient presenting with acute stroke.

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