Vol 135 No 1557: 1 July 2022

Time for Rangatiratanga

As July the first rolls around, in the time of renewal following Matariki, and the proposed revamp of the public health system is operationalised, Howard et al, in the current issue of the Journal, provide a timely reminder of the importance and responsibilities of clinical leadership in the health system.

Evaluation of community-based CT abdomen for acute abdominal pain during COVID-19 | OPEN ACCESS

Acute abdominal pain is common, accounting for 5–10% of emergency department presentations and with many potential causes ranging from benign to life-threatening. It is important to identify diagnoses quickly and accurately in order to start appropriate treatment, and to ensure optimal outcomes for patients.

Screening of diabetes in pregnancy in New Zealand: translation of national guidelines into practice

The prevalence of gestational diabetes mellitus (GDM) and pre-existing diabetes is increasing in Australia and Aotearoa New Zealand. Indigenous populations in both countries are disproportionately overrepresented among women with diabetes in pregnancy, including Māori (5.7% cf. 2.5% NZ European women) and Aboriginal and Torres Strait Islanders (pooled prevalence odds ratios of Indigenous cf. non-Indigenous women for pre-existing diabetes were 3.63 and 1.42 for GDM).

Thunderstorm asthma: a review, risks for Aotearoa New Zealand, and health emergency management considerations | OPEN ACCESS

Until recently, thunderstorm asthma (TA) was thought to be a relatively rare phenomenon, but recent events have resulted in it being labelled as a growing threat to public health.

Medical students’ experience of studying while working part-time and the effects of COVID-19 | OPEN ACCESS

Worldwide, cost of living and accrued debt causes stress for medical students. In addition to having one of the longest periods of study and paying fees twice that of many of their student counterparts, tuition fees for medical students are large and increasing.

Contemporary management of isolated free fluid on computed tomography scan in blunt abdominal trauma—experience from a Level 1 trauma centre in New Zealand

Although computed tomography (CT) is the gold standard for the assessment of haemodynamically stable BAT patients, the sensitivity of CT in detecting HVI, as well as mesenteric injuries is less than ideal.

Consent for teaching

The issue of consent for student involvement with patient care was raised by the Cartwright Inquiry. Evidence was presented that medical students were required to perform vaginal examination on anaesthetised women without their knowledge or consent. As a result of the Inquiry, the Code of Health and Disability Consumer Rights (HDC Code) was established that includes rights on consent for teaching (Rights 5,6 and 7). There are concerns that this requirement is not being observed, and a Consensus Statement (CS) was developed by Auckland and Otago medical schools on informed consent for teaching.

Doctors as leaders and governors

The health system in Aotearoa New Zealand (Aotearoa NZ) is implementing a significant reform agenda derived from the Health and Disability System Review. Unique to the Aotearoa NZ context, a key challenge facing the system and central to the reform agenda is a drive to achieve equitable outcomes, particularly related to Māori, Pasifika, and disabled populations.

The first Aotearoa New Zealand case of NUDT15-variant-related thiopurine-induced myelotoxicity

Thiopurines, such as azathioprine, 6-mercaptopurine, 6-tioguanine, are used commonly as steroid sparing agents and immuno-supressants for many auto-inflammatory conditions such as inflammatory bowel disease [IBD], anti-neutrophil cytoplasmic antibody [ANCA] associated vasculitides, rheumatic conditions, and solid organ transplantation.

A red scaly patch diagnosed as hypomelanotic melanoma

An asymptomatic 70-year-old male bus driver with phototype-2 skin was offered a total body skin examination following treatment of two keratinocyte carcinomas of the face. He had a history of a targeted skin examination of a leg elsewhere, two years previously, and had no significant co-morbidities.

Trends in maxillofacial fractures in Otago-Southland, New Zealand: 2009 to 2020

The incidence of maxillofacial fractures and their associated costs have steadily increased over the last 11 years, to the point where the latter now exceed NZ$90 million annually.

Current role of sentinel lymph node biopsy in early-stage melanoma

There has been significant evolution in the management of surgically resectable melanoma the past five years with the success of adjuvant therapy for stage 3, and more recently, high-risk stage 2 melanoma. In the context of these recent changes, the role of sentinel lymph node biopsy (SLNB), which has been debated for many years, has come under the spotlight again.

Abstracts for the 261st Otago Medical School Research Society Summer Student Speaker Awards, Wednesday 4 May 2022