Vol 135 No 1561: 2 September 2022

PDF

Issue Summary

Article

SUMMARY

Are patients receiving recommended bone protection therapy after a non-hip fracture? A retrospective study of the Fracture Liaison Service at Counties Manukau District Health Board

Ruveena Kaur, Sunita Paul, Elizabeth Prasad, Brandon Orr-Walker

An estimated 1 in 3 women and 1 in 5 men will experience a fragility fracture in their lifetime. Once a fracture occurs, a patient’s risk of subsequent fracture is increased, and bone protection medication may be recommended to reduce the risk. A fracture risk assessment is performed by the Fracture Liaison Service at Middlemore Hospital. However, due to a lack of funding, treatment implantation is left with the patient’s general practitioner. 1 in 5 patients newly referred to the Fracture Liaison Service had a history of a previous fracture. Nearly one third of patients who were recommended bone protection therapy did not receive this in a timely manner. This highlights an important issue of resource limitation. Addressing this may prevent further fracture, potential disability and loss of income for the patient, as well as from an economic perspective, reducing the need for medical intervention and/or hospital admission should a further fracture occur.

Article

SUMMARY

Artificial intelligence improves adenoma detection rate during colonoscopy

Cameron Schauer, Michael Chieng, Michael Wang, Michelle Neave, Sarah Watson, Marius Van Rijnsoever, Russell Walmsley, Ali Jafer

This is the first study in New Zealand to use an artificial intelligence machine during colonoscopy to help with finding bowel polyps, which may develop into colon cancer. The machine processes images real time and superimposes a green box over suspected abnormalities on the screen. This resulted in a 59% relative, or 9% absolute increase in precancerous polyp detection compared to colonoscopy without using it.

Article

SUMMARY

Illness perceptions and diabetes self-care behaviours in Māori and New Zealand Europeans with type 2 diabetes mellitus: a cross-sectional study

Jordine Romana, Mikaela Law, Rinki Murphy, Eva Morunga, Elizabeth Broadbent

This study asked 85 Māori and 85 NZ European patients who were attending diabetes clinics about their illness. Māori patients had poorer diabetes-related health outcomes and less healthy behaviours than NZ Europeans. Across both cultures, greater perceptions that treatment could control diabetes were associated with better medication adherence. To help address these health inequities, culturally appropriate psychosocial interventions need to be developed.

Article

SUMMARY

An evaluation of a New Zealand “vape to quit smoking” programme

Kelly S Burrowes, Chloe Fuge, Tori Murray, Jonathan Amos, Suzanne Pitama, Lutz Beckert

We compared the use of smoking cessation aids across different ethnic groups and age groups within a large New Zealand cohort and assessed the uptake and effectiveness of e-cigarettes for smoking cessation via a "vape to quit" initiative. The final dataset analysed including 1,118 participants; 66.6% NZ European, 28.1% Māori, 3.1% Pacific, 2.2% Asian. The use of vaping products, predominantly nicotine-containing products, to support smoking cessation has increased rapidly over time. We followed up 100 participants who had used vaping to quit smoking and found that after six months 16% were smoke and vapefree, 31% were smokefree and vaping, 31% were smoking and not vaping, and 22% were smoking and vaping. Nicotine containing e-cigarettes are showing potential in smoking cessation programmes in support of the Smokefree Aotearoa 2025; however, 22% of those in the "vape to quit" programme became dual users.

Article

SUMMARY

Whakarongorau abdominal pain review

Matt Wright, Fiona Pienaar

A study that looked at abdominal pain calls to Healthline, with this being the most common symptom that people call about. It described the types of callers, where they live, what time they call and then the recommended outcome from the calls. It showed that the callers to Healthline are broadly similar to other parts of the New Zealand healthcare system, for instance general practice and emergency departments. It compared the response to other countries and showed that the outcomes are likely as good or better. Whakarongorau is the organisation that runs Healthline and will continue to use the data around clinician behaviour to improve the overall care, by decreasing variation in responses.

Article

SUMMARY

A service evaluation to explore Māori experiences of direct-acting antiviral hepatitis C treatment in Aotearoa New Zealand

Joanna Hikaka, Lavinia Perumal, Natalie Gauld, Marara Metekingi, Rachel Mackie, Jenny Richards, Karen Bartholomew

Hepatitis C is a virus which is spread by blood-to-blood contact and affects up to 50,000 New Zealanders. Left untreated, it can cause liver damage which can impact daily life, however there is now a new and effective medicine which can cure hepatitis C in almost all those that are treated. This study focused on Māori experiences of hepatitis C treatment to help ensure that services that are designed are safe and effective for Māori. Participants expressed that treatment had positive benefits on mental and physical health. Proactive health professionals that made real connections with people and provided wrap-around services were valued.

Article

SUMMARY

Epidemiology of carbapenem resistant Acinetobacter baumannii in New Zealand

Matthew R Blakiston, Mark B Schultz, Indira Basu, Susan A Ballard, Deborah Williamson, Sally Roberts

The multi-drug resistant bacteria Acinetobacter baumannii is an important cause of hospital associated infection globally. There is increasing identification of multi-drug resistant Acinetobacter baumannii in New Zealand. This has occurred in association with the spread of a single strain between hospitals in Fiji, Samoa, and New Zealand.

Article

SUMMARY

Audit of cervical excision depth of large loop excision of the transformation zone procedures at Counties Manukau District Health Board

Sita T Clark, Hilary R Barker, Luke R Bradshaw, Jyoti Kathuria, Charlotte Oyston

This is the first study to audit the outcomes of patients undergoing large loop excision of the transformation zone (LLETZ) procedures at Counties Manukau District Health Board (CMDHB), relative to established colposcopy guidelines and standards of care. Differences in the excision depths were identified relative to Public Health England’s (PHE) established thresholds, with a large proportion of excisions being too shallow, particularly in patients with type 2 and type 3 transformation zones (TZ). These findings highlight the importance of considering the associated risks of LLETZ procedures in individual patients and the need to adapt the surgical approach and equipment used accordingly. Importantly, this study has also identified reduced rates of LLETZ procedures in Māori and Pasifika patients, emphasising the need for improved screening in these high-risk communities going forward. Finally, this study has highlighted the need to audit LLETZ procedures in other DHBs in New Zealand to identify issues and optimise the quality of care for CIN provided nationwide.

Article

SUMMARY

E-cigarette use patterns, brand preference and knowledge about vaping among teenagers (13–16 years) and parents of children attending Christchurch Hospital

Andreas Nicolaou, Amy Moore, Ben Wamamili, Tony Walls, Philip Pattemore

We conducted an anonymous online survey in the paediatric outpatient department at Christchurch Hospital from December 2021 to February 2022. The survey assessed e-cigarette use (vaping), brand preferences, and knowledge about vaping among teenagers aged 13-16 years and parents aged 17 years or older: 42 teenagers and 53 parents participated. Parents were more likely to vape at least once a month (15.1%) than teenagers (7.1%) and to vape in home or in car when other people were present. Teenagers vaped for curiosity and flavours and obtained vape products from sources other than vape shops.

Viewpoint

SUMMARY

Pākehā/Palangi positionality: disentangling power and paralysis | OPEN ACCESS

Andi Crawford, Fiona Langridge

This paper, written by two Pākehā/Palangi women working in Māori and Pasifika Health in Aotearoa, is a perspective on how tangata Tiriti health professionals and researchers must do better in our approach to improving health outcomes. Power is a key contributor to the perpetuation of colonisation and systemic racism in our health system. Paralysis immobilises us due to racism, apathy, guilt and fear of doing wrong. Positionality can move us out of paralysis by being conscious and open about our biases, perspectives, values, privileges, beliefs, superiority and identities. We suggest four practical tools of engagement (Learn, Reflect, Serve/Act, Disrupt) as approaches to dismantle power systems, overcome paralysis and recognise positionality.

Editorial