Vol 135 No 1563: 7 October 2022

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Issue Summary

Article

SUMMARY

A nurse-led and medically supported outpatient follow-up model following an acute coronary syndrome is as safe and effective as medical follow-up alone (ANZACS-QI 69)

Andrew McLachlan, Andrew Kerr, Mildred Lee

Heart attacks impact a large number of people every day and can leave people feeling stressed and anxious in the weeks following discharge from hospital. Cardiac rehabilitation offers support for people as they resume their lives however many do not take up this evidenced based support for a variety of reasons. Most people, however, do attend the outpatient follow up review in traditionally medical clinics. This is the first study to prove that suitably qualified and supported nurses can provide effective and timely outpatient care, as safely as their medical colleagues.

Article

SUMMARY

Sources of healthcare-associated Staphylococcus aureus bacteraemia in New Zealand acute hospitals

Ruth Barratt, Grace Clendon, Barbara Gibson, Sally A Roberts

Staphylococcus aureus is a bacterium that is often found on the skin. It can cause infections, especially if there is an opportunity for the bacteria to enter the body. A bloodstream infection with S. aureus is very serious. This study looked at how people acquired S. aureus bloodstream infections while receiving healthcare. One of the common sources of these healthcare-associated infections (HAI) was having a line into a vein for medication. Improving care around these lines will help reduce these infections. The recent national healthcare associated infection point prevalence survey published on the Health Quality & Safety Commission website identified that 66% of all inpatients had a medical device in situ, of which vascular access devices were the most common medical device in use. S. aureus was the most common pathogen causing HAI and 13% of patients with HAI had a blood stream infection. One quarter, 25%, of these events were due to vascular access devices.

Article

SUMMARY

Healthcare pathways for mild traumatic brain injury patients in New Zealand, determined from Accident Compensation Corporation data

Renata Bastos Gottgtroy, Patria Hume, Alice Theadom

Efficient concussion care is important for quick recovery and positive patient and whānau experience. Our analysis of 55,494 patients showed that while concussion healthcare pathways in New Zealand were efficient for most patients, 2 out of 3 patients did not receive follow up care. Administrative delays affected thousands of patients every year. One quarter of patients waited more than two months to be seen at a concussion clinic. Patient pathways could be improved by facilitating concussion diagnosis, improving patient follow-up rates and reducing unnecessary administrative processes.

Article

SUMMARY

Bleeding risk of oral anticoagulants in liver cirrhosis

Oriana Munevar Aquite, Michael Hayes, Kebede Beyene, Amy Hai Yan Chan, Cameron Schauer, Henry Wei, Jiayi Gong

In New Zealand, two common blood thinners taken via the mouth are routinely used to manage diseases involving blood clots and irregular heart rhythms. However, the safety of one blood thinner called dabigatran or Pradaxa has not been routinely studied in patients with liver disease. Our research was aimed at comparing the risk of bleed that may occur if patients were treated with either Pradaxa or the usual warfarin. We found no different in bleeding risk between the two treatments but as our study was small with modest number of patients, we cannot be completely certain that this finding was by chance.

Article

SUMMARY

Disability-Adjusted Life Years and cost of health loss of hospitalised major trauma patients in New Zealand

Belinda J Gabbe, Siobhan Isles, Paul McBride, Ian Civil

Injury is one of the leading causes of death in New Zealand, and survivors of injury can experience substantial impacts of injury including lost health-related quality of life and disability. Disability Adjusted Life Years (DALYs) provide a way of measuring the health loss associated with conditions such as injury, as well as the cost of that health loss, across populations. In this study, we measured the DALYs lost due to major trauma in New Zealand from July 2017 to June 2020. Each year, an average of 7,573 DALYs were lost at an estimated cost of $341 million, highlighting the substantial impact serious injury has on the lives of New Zealanders.

Article

SUMMARY

Revascularisation and outcomes after acute coronary syndromes in patients with prior coronary artery bypass grafting—ANZACS-QI 67

Danting Wei, Jithendra B Somaratne, Mildred Lee, Andrew Kerr

In patients presenting with a heart attack, a prior history of coronary artery bypass surgery was associated with a high burden of comorbidities when compared with patients without prior bypass. Prior bypass surgery patients had higher rates of death as well as non-fatal outcomes. Despite accounting for a growing proportion of patients presenting to hospital, deciding treatment modalities for this subgroup is still a complex and challenging process. Further trials are needed to study the management strategies to improve prognosis in this high-risk group.

Article

SUMMARY

Prevalence of frailty and frailty outcomes within the inpatient rehabilitation setting: use of routinely collected electronic health information

Himali Aickin, Katherine Bloomfield, Zhenqiang Wu, Martin J Connolly

Frailty refers to a syndrome that is associated with poor health outcomes such as falls, hospital admissions and entry to aged residential care. We developed a tool to measure frailty in older adults admitted for a period of inpatient rehabilitation at Te Whatu Ora Waitematā using data that was recorded electronically as part of the normal admission process. Over 90% of patients were identified as frail and therefore at risk of future adverse health outcomes. Those with high frailty scores had significantly higher risks of being readmitted to hospital or dying in one year. Identifying such high risk patients should be used to deliver appropriate patient-centred individualised care.

Clinical Correspondence

SUMMARY

Acute macular neuroretinopathy following COVID-19 infection | OPEN ACCESS

Luke Hawley, Louis S Han

Acute macula neuroretinopathy is a rare ocular disease that causes blind spots. There is now significant information linking COVID-19 infections and this disease. Doctors must be aware of this link and refer to appropriate specialties in cases like this post infection.

Editorial