Vol 136 No 1581: 25 August 2023

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Issue Summary

Editorial

SUMMARY

The rise (and possible fall) of ketamine treatment in New Zealand

Ben Beaglehole, James Foulds, Roger Mulder

Ketamine is an exciting new treatment for depression. Unfortunately, depression symptoms often return after the course of ketamine ends. This creates challenges for clinicians wanting to use ketamine in routine care. Other exciting treatments have offered promise previously, but the fullness of time is required to understand all the risks and benefits of new treatments.

Article

SUMMARY

Patients’ and clinicians’ views on shared decision making in cancer care: a qualitative study of Aotearoa New Zealand patients’ and clinicians’ perspectives | OPEN ACCESS

Karol J Czuba, Rachel Owens, Pieta A Brown, Te Hao Apaapa-Timu, R Matthew Strother, Ryan P Radecki

Our team wanted to understand how we can use digital health tools to enable patients to exercise their right to self-determination/rangatiratanga of health and wellbeing. We talked to 31 participants, including patients with cancer and clinicians. Their stories revealed a broad range of experiences in relation to SDM, highlighting a gap between the SDM expectations and its practice. Patients and whānau want to participate in making decisions about their care, to hold authority in this process and to have their needs and preferences considered beyond the biomedical model. However, there are multiple barriers that limit patients’ engagement in SDM, including lack of clinical time and resources, patient and clinician attitudes, inherent healthcare system constraints, and the overall uncertainty surrounding cancer care. Our findings contribute to building Te Tiriti responsiveness across the cancer care and other health care settings; for example, by recognising patients’ preferences for treatments such as rongoā (traditional Māori healing) and that Māori approaches to health and wellbeing are holistic and encompass concepts of collectivism rather than individualism. Future work should focus on key content and design features of decision tools, supporting SDM processes, improving information transfer and comprehension, and facilitating equitable experience and outcomes of cancer care for all patients.

Article

SUMMARY

Caregiver experiences of racism and child mental health outcomes: cross-sectional analysis from Aotearoa New Zealand

Rebekah Jaung, Chao Li, Ricci Bernette Harris, Sarah-Jane Paine

Caregiver experiences of racism (indirect racism) may impact on children’s perception of the world as being fair and just, thus negatively impacting on their sense of mental wellbeing. This study aimed to measure how common indirect racism in New Zealand is and investigate the association between this indirect racism and diagnosed child mental health conditions. Data from 2,989 child–caregiver pairs showed that almost 20% of caregivers had experienced “any” racism ever. Children in Māori, Pacific, and Asian ethnicity groupings experience significantly higher exposure to indirect racism than those in the European/Other grouping. Multiple experiences of indirect racism are associated with increased chance of diagnosed child mental health conditions. These results, alongside existing research about racism as a determining factor for health, should be received with concern about the damaging effects of racism, colonisation, and white supremacy on health, and provide strong motivation for health system and whole-of-society action.

Article

SUMMARY

Equity of Māori access to the orthopaedic rehabilitation service of the Bay of Plenty: a cross-sectional survey

Lachlan Cate, Nigel Giles, Bert van der Werf

We surveyed all patients in the Bay of Plenty who underwent knee replacement surgery in 2021. They were asked to document the rehabilitation they accessed before and after surgery, as well as the location at which they accessed this rehabilitation. On average, Māori patients accessed more rehabilitation (9.75 total hours) than non-Māori patients (8.34 total hours). This was in large part driven by a significant home-based component of their rehabilitation. We suggest that breaking down transport barriers is an effective method of promoting access to health services for Māori.

Article

SUMMARY

Administration of Routine Antenatal Anti-D Prophylaxis (RAADP) in Wellington, Aotearoa: is our practice equitable?

Zoe Lahood, Judy Ormandy

Routine Anti-D injections are given to Rhesus-negative pregnant people to prevent isoimmunisation. Isoimmunisation causes significant pregnancy complications. Hospital guidelines for Anti-D administration were not followed and there was evidence of inequity. People cared for by a private obstetrician, living closer to hospital, and birthing at a tertiary hospital were more likely to have received routine Anti-D.

Article

SUMMARY

Endometrial cancer diagnoses prompted by routine cervical cytology: a retrospective case study

Rhiannon CE Mertens, Peter H Sykes, Carrie R Innes, Bryony J Simcock, Simone Petrich

This study aimed to estimate the number of women who have diagnoses of endometrial cancer prompted by an abnormal cervical screening test as part of the National Cervical Screening Programme (NCSP). This is important to understand because soon the cervical screening test will test for the human papillomavirus (HPV) and not look at cells. It was found that 26 of the 334 women (7.8%) in the study had their endometrial cancer prompted by abnormal endometrial cells picked up on the cervical cell test. The disease characteristics in these cases were most often classified as less aggressive. It remains unclear what the impact of delayed diagnosis will be for these women; however, as most have less aggressive disease it is unlikely to be severe.

Viewpoint

SUMMARY

Low risk of variant Creutzfeldt-Jakob disease transmission from blood transfusions in Aotearoa New Zealand suggests donor exclusion policies can be relaxed

David T S Hayman, Michael G Baker

Aotearoa New Zealand excludes potential blood donors who lived in the United Kingdom for six months or more between 1980 and 1996. This policy is due to the “mad cow disease” epidemic in cattle there causing variant Creutzfeldt-Jakob disease (vCJD) in humans who could potentially pass on this infection through blood transfusions. As a result, 10% of New Zealand’s active blood donors were excluded, contributing to periodic shortages of some blood products. Cases of vCJD peaked 23 years ago in 2000 and are declining, with no new cases since 2019. Only three confirmed cases have ever been linked to a blood transfusion. We calculated the risk of relaxing these restrictions to lead to approximately 1 in 1 billion risk per year nationally, similar to a recent 1 in 1.45 billion estimate for Australia. This calculation suggests that relaxing current blood donation restrictions, like Ireland and Australia’s recent policy changes, would lead to an extremely low risk of vCJD transfusion-transmission in New Zealand. This change would increase the supply of blood products for multiple medical needs.

Clinical Correspondence

SUMMARY

Cryptorchidism in a young man with learning disabilities returns as advanced testicular cancer

Morgan J Bressington, Ludewikus Vermeulen

Our case explores the story of a young man with learning disabilities who presents with an aspiration pneumonia. Investigations show this to be sequalae of an abdominal mass stemming from an advanced primary seminoma. We discuss why men with learning disabilities demonstrate a higher incidence of testicular cancer as well as worse outcomes and identify ways to reverse this phenomenon.

Research Letter

SUMMARY

Impact of a non-medical switch from tocilizumab to upadacitinib in a cohort of patients with rheumatoid arthritis in routine clinical practice

Douglas White, David Poppelwell

In New Zealand, some adults with rheumatoid arthritis, a disease that causes inflamed joints, had their medication switched from an intravenous injection (tocilizumab) to a tablet (upadacitinib). This study looked at the effect of this. Following the switch, 6 months later most patients stayed on upadacitinib. Their rheumatoid arthritis was controlled, and they found upadacitinib convenient.

Research Letter

SUMMARY

Seen and unseen work: the intensity of service provision for individuals with type 2 diabetes in a high-needs population

Christine Barthow, Nadine Kuiper, Bryan Betty, Ioana Viliamu-Amusia, Linda Bryant, Dipan Ranchhod , Erin Millar, Eileen McKinlay, Jeremy Krebs

Funding and sustainability of primary healthcare are urgent priorities to address if the recent health reforms are to achieve equitable health outcomes for all New Zealanders. Services operating as Very Low-Cost Access general practices provide care to populations with disproportionately high health and social needs; however, the complexity, volume and nature of work done by these practices is poorly understood. This case note review analysed the care provided to adults with diabetes attending a Very Low-Cost Access practice over a year and found these individuals had multiple health conditions, used many medications and multiple different types of staff were involved and provided very frequent care for most of the group. Findings highlighted the hidden, as well as the visible, complexity of work for such patients and extremely low fee-for-service invoiced to individuals when contrasted with the intensity of services provided and current funding models.

Editorial