Vol 135 No 1564: 28 October 2022

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Issue Summary

Article

SUMMARY

Risk factors for readmission in patients with acute diverticulitis: a retrospective study at Auckland City Hospital

Stina Höckert, Patricia Maldonado Valdivieso, Rebekah Jaung, Pamela Buchwald, Ian Bissett

After acute diverticulitis, patients who presented with a collection, a previous history of the disease or Māori origin have a higher risk of recurrence. The findings about ethnicity needs further investigation utilising appropriate research methodologies.

Article

SUMMARY

Audit of the Southern DHB B4 School hearing screening referral process: is there unmet need?

Thomas Oliver, Paul Joice, Patrick JD Dawes

The B4 School Check for hearing works well in Otago and Southland, it identifies those at risk of hearing loss and has good guidelines for managing these children. The check also shows that more Māori and Pasifika children may have glue ear compared to others and this warrants attention so that and hearing loss is managed as they commence school.

Article

SUMMARY

The effect of COVID-19 on orthopaedics in Aotearoa New Zealand—a survey of orthopaedic surgeons and training registrars

Matthew J Bowman, Scott M Bolam, Mark Wright

This study is surveyed New Zealand orthopaedic surgeons and registrars who are training to be orthopaedic surgeons to assess the impact of COVID-19. Both consultants and training registrars felt more burnt out because of the pandemic. Theatre productivity was believed to have reduced significantly. The disruptions caused by COVID-19 significantly impacted the training for both registrars and consultants.

Article

SUMMARY

Improving early detection of colorectal cancer in Aotearoa New Zealand; how do the direct access criteria perform?

Rhys A John, Holly Wang, Valentyna Sylevych, James D Falvey

In New Zealand, patients with gastrointestinal symptoms can be referred for colonoscopy or other equivalent tests if they meet certain national criteria (which include an age range, symptoms such as the presence of blood in the stool, and whether the patient has a low red blood cell count caused by iron deficiency). Our study looked at all colonoscopy referrals to Christchurch Hospital through this referral pathway during the year 2018 to examine, amongst other outcomes, how the current criteria perform at detecting colon cancer. Of the 3,200 referrals, 128 patients were found to have colon cancer, which is only 4.0% of the referred patients. This can be thought of as the number of colonoscopies needing to be performed to detect one cancer being 25. Due to the pressure on colonoscopy resources in New Zealand, we argue that the current performance of the pathway is inadequate primarily due to the poor performance of a patient’s symptoms alone in determining colon cancer risk, and this leads to a large number of colonoscopies being performed with a low cancer “yield”. An improved pathway is required, which might combine symptom-based criteria with the addition of a test to detect the presence of blood in the stool (similar to the test used in the national bowel screening programme). This approach has been enacted in the UK in order to better target colonoscopy resources and has been shown to outperform symptom-based criteria.

Article

SUMMARY

Microvascular reconstruction outcomes from a New Zealand Oral and Maxillofacial Surgery Unit

Hannah Maher, Ellen Simpson, Thasvir Singh

Treatment of large defects in the oral cavity is unique because of the many roles of the oral cavity. Commonly tissue grafts including muscle, fat, skin, blood vessels +/- bone are used in the reconstruction. The operation is often long and requires specialist training. Waikato Hospital is the only tertiary centre in New Zealand where this surgery is done independently by oral and maxillofacial surgeons. The aim of this study was to audit the outcomes of patients treated by this department to ensure they are receiving quality care. The results show that the Oral and Maxillofacial Department at Waikato Hospital have results similar or better than most results from other departments both nationally and internationally.

Viewpoint

SUMMARY

Radiology and Te Whatu Ora – Health New Zealand in 2022. Why we should all care

Anthony James Doyle

Radiology is a key enabler of clinical medicine and has been shown to be highly cost effective. Demand and activity have increased over time, with demand for computed tomography (CT), magnetic resource imaging (MRI) and ultrasound (US) growing faster than population growth. Resources in the public sector have not kept up with demand, exacerbated by the COVID-19 pandemic. A reliance on an overseas trained workforce has resulted in critical shortages. This paper covers the areas of need and how these can be addressed over the next few years.

Clinical Correspondence

SUMMARY

Severe cutaneous reaction to the messenger RNA (mRNA) BNT162b2 (Pfizer–BioNTech) vaccine | OPEN ACCESS

Sabrina Sapsford, Blair Wood

The Pfizer vaccine is very safe and has saved millions of lives around the world. This paper discusses a rare case of a severe skin reaction after vaccination. The patient did well after dermatology input and management. We need more dermatologists, funded by the Government, to work in the public sector and allow hospitalised and community patients with skin conditions to be seen early and managed well.

Clinical Correspondence

SUMMARY

Spindle cell lipoma of the epiglottis: a potential airway emergency

Sejad Ahmadzada, Joyce Pui Kiu Ho, Kartik Vasan, Tony Shih-Wei Kuo

Lipomas are non-cancerous fatty tumours that can arise in the head and neck region. When it arises in the larynx (lower throat), it can result compression of the airway and is a potential airway emergency. Individuals who have new onset of symptoms such as snoring and globus sensation (feeling of something stuck in their throat) should be referred to an Ear, Nose, Throat Surgeon for review. Lipomas can be removed surgically and individuals who undergo this tend to have good prognosis.

Editorial