Vol 136 No 1580: 4 August 2023

PDF

Issue Summary

Article

SUMMARY

Atrial fibrillation and anticoagulation in patients hospitalised for stroke in the REGIONS Care Study

Syrah Morgaine Ranta, Ralph Stewart, Stephanie Thompson, Alan Davis, P Alan Barber, Matire Harwood, Annemarei Ranta

Atrial fibrillation is an irregular heartbeat that can lead to blood clot formation in the heart, leading to stroke. About a third of people with stroke have atrial fibrillation as an underlying condition and strokes in this setting can be prevented by taking blood thinners. Both prescribers and patients can be reluctant to take blood thinners because they may be concerned about bleeding side effects. Our study showed that one third of people with atrial fibrillation were not taking blood thinners when they presented with a stroke, that most of these would have been eligible to take blood thinners, but both patients and prescribers showed reluctance. Our study also found that people taking blood thinners were no more likely to present with a bleeding type of stroke than those not taking blood thinners. Māori are at particularly high risk for stroke due to atrial fibrillation, and it was reassuring to see that blood thinner use among Māori was no less than among non-Māori. However, both groups could benefit from higher rates of prescribing/use of these life-saving medications and tools to support, especially primary care providers, in the shared decision-making process.

Article

SUMMARY

Implementing and assessing the acceptability of a portable, readily accessible, and actionable end of life planning tool for patients with advanced serious illness or frailty in southern New Zealand

Laura Mulligan, Amanda Sommerfeldt

The Clinical Order Articulating Scope of Treatment (COAST) form was designed as a single-page medical order communicating plans for medical treatment for adult patients believed to be in their final year of life, following discussion with a health professional. Prior to introducing COAST, each health provider or agency in the Southland region of New Zealand had its own forms and processes; the COAST pilot attempted to consolidate and streamline these varied processes into one form that is valid throughout the region. This three-phase initiative involved piloting use of the COAST form in Southland between May 2019 and January 2020. Surveys were given to patients at the time of COAST form completion and distributed electronically to health professionals at the end of each phase to assess attitudes towards COAST form use and obtain feedback. The response rates for patient and health professional COAST experience surveys were relatively low but the feedback was positive, with the majority of respondents expressing that the COAST form improved patient care. Implementation of the COAST form has been widely accepted by patients, families, and health professionals alike.

Article

SUMMARY

Envisioning a Tiriti-responsive New Zealand Health Plan: lessons from district health boards’ annual plans

Nina Bevin, Kyle Eggleton, Sarah Herbert

While DHBs’ annual plans expressed commitment to Te Tiriti o Waitangi, their content did not give effect to these commitments. Significant shifts are necessary if future New Zealand Health Plans are to meaningfully deliver Tiriti-responsive health services.

Article

SUMMARY

Identifying potential patients with diabetes-related dementia: a descriptive approach using routinely collected data

Cristian Gonzalez Prieto, Ruby Hosking, Jasmine Appleton, Susan Yates, Yu-Min Lin, Bede Oulaghan, Claudia Rivera-Rodriguez, Daniel Wilson, Gillian Dobbie, Sarah Cullum

A new subtype of dementia associated with diabetes has been studied in Japan since 2013, called diabetes-related dementia. Given the high occurrence of diabetes and dementia in New Zealand, the suggestion of a diabetes-related dementia is of interest. Our findings may indicate a new subtype of dementia which could influence future personalised treatment and prevention approaches.

Article

SUMMARY

Multiple symptom illness in New Zealand contemporary veterans

David Iain McBride, Amy Richardson, Dianne Gardner, Emma H Wyeth, Daniel Shepherd, Sarah Derrett, Claire Cameron

Persistent physical symptoms, such as joint pain, stiffness, and loss of sensation, along with psychological symptoms such as avoiding doing things, sleeping difficulties and tiredness, was first described in veterans as “Gulf War Illness” and was medically unexplained—not fitting within a medical diagnosis. We looked for this in New Zealand veterans and, based on severity, grouped 26 symptoms in three groups: firstly, arthro-neuromuscular (muscle and joint pains, tingling, loss of balance), secondly, psychological (feeling distant, avoiding doing things, sleeping difficulties and dreams), and thirdly, “ill-defined physical symptoms” (swollen glands, fever, sore throat). Our results suggest that, while there may be no unique symptom pattern, multiple symptoms, especially if severe and persistent, may be related to post-traumatic stress disorder (PTSD). It may be worthwhile to do a more formal evaluation for PTSD in these cases.

Viewpoint

SUMMARY

Voices for health: going, going, going…

Boyd Swinburn

The new health reforms aim, as their core purpose, to improve the health of New Zealand’s population, especially for those groups currently experiencing worse health outcomes. The most effective way to do this is through prevention measures which lie outside the hospital walls or GP surgeries. We need many voices calling for these prevention strategies, but the centralisation of the new health systems has resulted in a loss of public voices for health from within, and the demise of the NZ Medical Association after 136 years of service is a lost voice for prevention from without. Health Coalition Aotearoa is building a collective voice from health organisations for stronger preventive regulations on tobacco, alcohol, and unhealthy food.

Viewpoint

SUMMARY

Abortion law in Aotearoa New Zealand

Felicity Goodyear-Smith

This article outlines the history of abortion law in Aotearoa New Zealand from colonial times to the present. The abortion struggle serves as an illustration of our changing political and social landscape. This was a remarkable period in our history, and there are many tales of extraordinary events and courageous acts, with moral crusaders, activists, legislators, abortion-providers, and many others on both sides of the debate putting their reputations and sometimes their lives on the line to do what they thought was right. With the 2020 law change abortion is no longer a crime, but events in the United States have shown how quickly change can occur, with their Supreme Court overturning Roe v Wade and states now banning abortions, so we should not be complacent.

Clinical Correspondence

SUMMARY

Candida auris: lessons learnt from the first detected case in Aotearoa New Zealand

Shivani Fox-Lewis, Leanne Buckwell, Wendy McKinney, Ruishan Tang, Graham Upton, Bindu Francis, Sally Roberts

Candida auris is a yeast that can cause infections in people. It has spread quickly worldwide and is a problem because it can be resistant to antifungal medication, spread easily in healthcare settings, and cause serious infections. This is a report of the first time this yeast has been detected in Aotearoa New Zealand. We share important learning points for healthcare organisations to consider when preparing their response to this global threat.

Editorial

SUMMARY

Is it time to reduce the age of screening for colorectal cancer?

Oliver Waddell, Tamara Glyn, Frank Frizelle

Colorectal cancer is increasing dramatically in those under 50, as seen in recently in the news with journalist Jo Mackenzie and comedian Dai Henwood. This is happening around the world—we do not know why, but the cause seems likely to be environmental. However, by screening earlier for colorectal cancer, this phenomenon seems to be reduced or avoided. We should reduce the age of screening to 40 in Māori and Pasifika and 45 in non-Māori, non-Pasifika.

Editorial