Issue

Vol 135 No 1559: 5 August 2022

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Issue Summary

Viewpoint

SUMMARY

Delay in funding of tolvaptan for polycystic kidney disease in Aotearoa New Zealand

Tracy Chan, Walter van der Merwe, Janak R de Zoysa

Autosomal dominant polycystic kidney disease is an inherited disease which can lead to kidney failure. It is fifth most common cause of end stage kidney failure in Aotearoa New Zealand. Tolvaptan has been found to slow the decline of kidney failure in some patients. However, the cost of Tolvaptan precludes a lot of patients from being able to afford this medication. Funding of Tolvaptan would certainly benefit eligible patients in Aotearoa New Zealand.

Article

SUMMARY

Smokefree and vapefree streets: high levels of support from tourists, residents and businesses, implications for tourist-destination communities in New Zealand

David Brinson, Charlotte Ward, Cheryl Ford, Annabel Begg

This study was designed to evaluate the attitudes of local businesses, residents, and visitors regarding the trial of a voluntary smokefree and vapefree zone covering the central business streets of a popular tourist town in the South Island of New Zealand, Hanmer Springs. Considerable effort was directed towards accurately measuring the level of support for the initiative in Hanmer Springs, by seeking opinions from nearly 1,000 respondents across a broad range of stakeholder groups, using a variety of survey methods. Results indicated strong public support for current smokefree outdoor areas to also be vapefree. The initiative was particularly attractive to visitors, with 95% of visitors surveyed indicating that they would be more likely or as likely to visit other places in New Zealand with similar smokefree and vapefree outdoor areas. We conclude that smokefree and vapefree zones will have an overall positive impact over the long term, which will support New Zealand’s smokefree 2025 goal.

Clinical Correspondence

SUMMARY

Neurotuberculosis with paradoxical reaction treated with infliximab: case report and literature review

Grace Chia, Tait Bartlett, Cindy Towns, Timothy Blackmore

In this paper, we describe a fatal case of a young woman with fully susceptible (no resistance to treatment) Mycobacterium tuberculosis affecting her brain, spinal cord and lungs. Despite all efforts and treatments, she unfortunately developed significant disability and became fully dependent for all her daily personal cares. With this, we also describe the difficult challenges of providing end of life cares from the barriers from being a transmissible infection (contagious) and in the setting of COVID-19 global pandemic further preventing family from visiting.

Article

SUMMARY

Motivators and barriers to general surgery as a career among junior doctors and medical students in New Zealand

Leah Boyle, Adam Payne, Sharon Jay, Jeremy Rossaak

Interest in choosing a general surgery as a career is affected by a range of motivators and perceived barriers. These differ between gender and ethnicities but the most important factors are clinical and practical aspects and work–life balance. Significant barriers are the perceived training hours and being overwhelmed. There is a perceived gender and ethnicity bias in general surgery. All the above factors need to be taken into account in order to try and increase the interest in general surgery as a career.

Article

SUMMARY

Parents and caregivers experience in managing children’s medicines after discharge from a New Zealand hospital

Rajeshni Naidu, Debbie Bassett-Clarke, Ross Nicholson, June Tordoff

Managing children’s medicines by parents/caregivers at home can be challenging. This study, carried out at one of the children’s hospitals in New Zealand, shows how parents/caregivers from different ethnic backgrounds, including Māori and Pacific Island, require appropriate and consistent information on discharge medicines from doctors, nurses and pharmacists for safe delivery of medicines to their children at home. The study demonstrates how parents/caregivers did not have appropriate measuring equipment to give medicines safely to their children at home. A standardised discharge process is needed to ensure parents/caregivers are given clear, consistent and easy-to-understand information on their children’s medicines. It is important for health professionals to use health literacy strategies including written information, using interpreters and providing measuring equipment with instructions to improve parent/caregiver understanding and management of their children’s medicines at home.

Clinical Correspondence

SUMMARY

Visual recovery following surgical intervention for pituitary apoplexy correlated with preoperative optical coherence tomography

Vidit Singh, Richard Holmes

This is a case report of a 52-year-old female who was referred by her optometrist to the acute eye clinic with three weeks of headache and progressive peripheral visual field loss in a distinctive pattern (as seen on testing with a visual field testing machine). An MRI scan (Magnetic Resonance Imaging – a type of cross-sectional scan providing clear images of the structures of the brain) revealed bleeding at the pituitary gland (a structure in the brain that plays in important role in hormonal regulation) which was causing compression of the optic nerves (the nerves connecting the retinas of the eye to the visual cortex of the brain) at the optic chiasm (a region in the brain near the pituitary gland, where part of each optic nerve crosses over to the opposite hemisphere of the brain). The patient had removal of the pituitary bleed by the neurosurgical team and careful replacement of hormonal deficiencies by the endocrinology team. Optical coherence tomography scans (specialised cross-sectional scans of the different layers of the retina) were performed before the patient proceeded to surgery and suggested damage to the optic nerves particularly in the left eye. The final visual field tests showed an essentially complete recovery in the right eye and a small persistent visual field defect in the left eye, which likely correlated to the greater damage to the left optic nerve suggested by the preoperative OCT scan.

Letter

SUMMARY

New Zealand’s first practical demonstration of the telemedicine system specific to ophthalmology: MedicMind teleophthalmology platform

Christopher Robert Giles Arthur, Renoh Chalakkal, Ben O’Keeffe

In our letter to editor we have outlined the importance and potential for teleophthalmology to be implemented into the New Zealand healthcare system. Teleophthalmology will enable New Zealand citizens to receive better ophthalmic medical care, particularly in rural locations and in primary care. We have drawn attention to recent televised media, that showcases the teleophthalmology concept to the New Zealand public.

Article

SUMMARY

“I teach them. I have no choice”: experiences of primary care among transgender people in Aotearoa New Zealand

Kyle K H Tan, Rona Carroll, Gareth J Treharne, Jack L Byrne, Jaimie F Veale

This study found that transgender people have a harder time than other people when it comes to getting healthcare from a primary care provider. They are more likely to feel like their doctor does not understand them, to have more confidence in their GPs, and to report that GPs involve them in decisions about their care. They are also more likely to have problems with transportation and cost. The study also found that transgender people's experiences are shaped by their healthcare environment and the resources they have available to them.

Clinical Correspondence

SUMMARY

Symptomatic vertebrobasilar artery stenosis treated with enoxaparin

Karim M Mahawish

Narrowed blood vessels within the brain (intracranial stenosis) is a common cause of troke worldwide, more commonly seen in those of Asian ethnicity. It is caused by the usual culprits such as smoking, diabetes and high blood pressure. People who are FAST positive should present immediately to hospital as they may benefit from clot busting treatments. In others, standard medical treatment with blood thinning medication is not always effective, and as in our examples, treatment with heparin or stents may be beneficial.

Article

SUMMARY

A comparison of the performance of saliva and nasopharyngeal nucleic acid amplification testing for the detection of SARS-CoV-2 in New Zealand

Gary McAuliffe, Timothy Blackmore, Juliet Elvy, Shivani Fox-Lewis, Brent Gilpin, Jenny Grant, Radhika Nagappan, Erasmus Smit, Chor Ee Tan, Fernalynn Tiongko, James Ussher

Article

SUMMARY

Utility of data linkage for orthopaedic service planning in the paediatric population with cerebral palsy at Starship Children’s Hospital

Wendy He, Alexandra Sorhage, Nichola C Wilson, N Susan Stott

In this study, the surgical procedures performed at Starship Children’s Hospital over a five-year period were described and demographic data were obtained via data linkage. It showed that data linkage could be used at the national level to identify regional differences and assist with surgical planning. Furthermore, potential inequities in the health system were identified. Further research with Māori Health researchers and the NZCPR is needed to investigate this matter further.

Letter

SUMMARY

Indoor air quality, largely neglected and in urgent need of a refresh

Julie Bennett, Caroline Shorter, Amanda Kvalsvig, Lucy Telfar Barnard, Nick Wilson, Julian Crane, Jeroen Douwes, Chris Cunningham, Phoebe Taptiklis, Robyn Phipps, Bill Trompetter, Manfred Plagmann, Mikael Boulic, Jennifer Summers, Terri-Ann Berry, Michael G Baker, Philippa Howden-Chapman

People spend the majority of their day indoors, where pollutants, including the virus that causes COVID-19, can accumulate if there is insufficient ventilation. Prolonged exposure to some pollutants can be harmful to your health. While there are guidelines for outdoor air pollutants, none exist for indoor air pollutants. New Zealand needs a national strategy to improve indoor air quality, with a focus on health and wellbeing outcomes. Such a strategy should set national guidelines for harmful pollutants as well as maximum carbon dioxide (CO2) levels, as a proxy measure for ventilation. An investment in clean indoor air could bring benefits other than reducing COVID-19 transmission, including reduced sick leave, improved cogitative function, reduced asthma and a reduction in GP visits and hospitalisations.

Editorial