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Issue

Vol 136 No 1583: 6 October

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Issue Summary

Editorial
SUMMARY

The imperative to tax ultra-processed food if political parties are serious about improving mental health in future generations

Julia J Rucklidge, Roger T Mulder

There is now robust research highlighting the strong association between consumption of ultra-processed products (UPF) and poor mental health. The data are most concerning in pregnancy. The more UPF the mother eats and/or the less whole foods she eats, the greater the risk of her child developing mental health problems. Successive governments are silent on the dangers of UPF food on mental health. With rising numbers of people struggling with mental health problems alongside the crippling costs to health, we need forward and transformative initiatives to tackle this problem. Taxing UPFs would be one avenue to adjust the fiscal levers to sway more people to make healthier food choices.

Article
SUMMARY

Goals of care in the Wellington Emergency Department: a clinical audit

Jesse Cain, Brad Peckler, Sinéad Donnelly

New Zealand has an ageing population where many older persons present to the emergency department. There are many treatment options from curative to comfort-based care. Goals of care discussions explore treatment options with patients to formulate an appropriate care plan if they are to deteriorate. These discussions reduce aggressive treatment, hospitalisation, and cost to the healthcare system. We aim to determine how often goals of care are being discussed in the emergency department for older persons.

Article
SUMMARY

Head and neck continued: a retrospective analysis of neck dissections from a New Zealand oral and maxillofacial surgery unit

Ellen OY Simpson, Alastair Luo, Jamie Mckenzie, Monish M Maharaj, Thasvir Singh

The Oral and Maxillofacial Surgery (OMS) Unit at Waikato Hospital is one of the only OMS units in New Zealand to ablate oral cavity malignancies and reconstruct the defect with vascularised free flaps. This study’s aim was to retrospectively analyse the demographics, nodal yields and metastatic rates, and complications of patients that underwent a neck dissection within the OMS unit. The paper concluded that the OMS unit recommends omission of neck dissection levels IIb and IV in cN0 cases if deemed oncologically safe to do so.

Article
SUMMARY

Cascade of care and rapid treatment pathway at Auckland City Hospital for patients with a new diagnosis of HIV infection, 2015–2019

Annabelle Donaldson, Michele Lowe, Simon Briggs

Early initiation of antiretroviral therapy for people living with HIV has been shown to reduce transmission of HIV and improve health outcomes for people living with HIV. For people with newly diagnosed HIV referred to Auckland City hospital between 2015 and 2019, 197/200 (98.5%) were initiated on HIV treatment and of these 99% (195/197) had confirmed suppression of their virus. Policy changes in 2017 enabled a rapid treatment pathway to be established and this has led to a significant shortening of time from diagnosis to starting treatment. It is important that there is increased testing for HIV in New Zealand as there is effective treatment that keeps people well and prevents HIV transmission.

Article
SUMMARY

Exploring health professionals’ viewpoint of provision of nutrition advice for women with endometrial cancer

Linda Williams, Claire Henry, Bryony Simcock, Sara Filoche

Of the 20 most common cancers, endometrial cancer has the strongest association with high weight. Individuals who survive endometrial cancer are at high risk of experiencing morbidity and mortality from cardiovascular disease due to shared risk factors. This study explored access to nutrition advice as part of survivorship care through interviews with health professionals. How to navigate conversations about high weight, access to limited resourcing, and health professionals feeling powerless to overcome system influences were all identified as barriers. A supportive environment and community approach were identified as facilitating delivery and uptake of nutrition advice.

Article
SUMMARY

A glimpse into the incidence and mortality of aortic dissection in Aotearoa New Zealand

Eric TA Lim, Adib Khanafer

Aortic dissection is a lethal medical diagnosis resulting in a tear in the main blood vessel coming out from the heart, known as the aorta. Currently published studies worldwide are showing that there is a trend towards a global rise in the incidence of aortic dissection. Unfortunately, there is no nationally available study performed here in Aotearoa New Zealand. Our study is the first to nationally map out the incidence and deaths from aortic dissection. Our results are concordant and show a similar rise in the incidence of aortic dissection and a gradual decline in death rates from aortic dissection in Aotearoa New Zealand.

Viewpoint
SUMMARY

Connectivity for point-of-care testing results: a call for change

Samarina MA Musaad, Vanessa Buchan, Geoff Herd, on behalf of the NZ POCT AG

Every New Zealander has the right to a good standard of healthcare, and has the right, if chosen, to have their results available to their healthcare providers. If this right is given to some and not others, this creates an unfair health service. Point-of-care tests are tests done outside of the laboratory near the patient, for example, RAT tests for COVID-19 done at a pharmacy, or urine pregnancy tests done at home. Connecting point-of-care test results means that the results automatically get transferred electronically to the patient’s medical record. If the result of a point-of-care test does not get electronically transferred to the patient’s medical record it means that: • The healthcare provider may not know the test was done. • The healthcare provider will not be able to see the result. • If the result is recorded incorrectly, the healthcare provider will have a wrong result for their patient. All these situations mean that the healthcare provider may not have the correct information to make correct decisions, and so the patient or whānau may not get the best possible healthcare. This article is written to remind decision makers of the avoidable risks to the patient when point-of-care testing results are not electronically transferred, and that electronically transferring these results is no less important than transferring results from a laboratory.

Clinical Correspondence
SUMMARY

Watch that bite: syncope versus seizure

Tony Zhang

This case portrays an exaggerated example of a relatively common clinical sign. A patient with repeated episodes of unexplained “blackouts” was referred for a second opinion on the aetiology. The major clinical clue on examination was the presence of lateral tongue biting, which is highly specific for “ruling in” seizures. The striking feature demonstrated in the image was the presence of accessory tongue tissue as a result of repeated tongue biting over the last few months.

Research Letter
SUMMARY

A review of 19 years of anaphylaxis cross-reactivity data to muscle relaxants in New Zealand

Zyllan P Spilsbury, Han Truong

We report the rates of anaphylaxis cross-reactivity of neuromuscular blocking agents (NMBA) for patients who have undergone skin testing after a confirmed allergic event in clinical practice. In cases of NMBA anaphylaxis, the index NMBA alone cannot be used to predict alternative NMBAs for safe future use and referral to a specialist anaesthetic allergy centre remains advised.

Viewpoint
SUMMARY

Continued mitigation needed to minimise the high health burden from COVID-19 in Aotearoa New Zealand

Michael G Baker, Amanda Kvalsvig, Michael J Plank, Jemma L Geoghegan, Teresa Wall, Collin Tukuitonga, Jennifer Summers, Julie Bennett, John Kerr, Nikki Turner, Sally Roberts, Kelvin Ward, Bryan Betty, Q Sue Huang, Nigel French, Nick Wilson

The next phase of the COVID-19 pandemic response should integrate control of this disease into a comprehensive respiratory infectious disease mitigation strategy that also covers influenza and other serious respiratory infections. This combined approach would increase the effectiveness and efficiency of the response. This is the view of 16 leading New Zealand scientists and doctors who have worked actively on the pandemic response. They have written the most comprehensive summary of the pandemic published so far, covering the first three and half years. They note that the pandemic has not gone away and remains an important cause of illness, hospitalisation, long Covid and death (it is currently New Zealand’s number one infectious disease killer ahead of influenza), so needs a continuing, strong, evidence-based response. The authors conclude that New Zealand delivered amongst the best pandemic responses in the world, keeping cumulative excess deaths close to zero, and saving an estimated 20,000 lives compared with the mortality rate seen in countries like the United States. Remarkably, it did this using restrictions that were amongst the lowest used by high-income countries (the average stringency of control measures in New Zealand was less than in Sweden, for example). They hope that future Governments will build on this world-leading response which offers a high degree of health protection for severe future pandemics.

ALL ARTICLES
SUMMARY
Editorial
Vol 136 No 1583: 6 October

The imperative to tax ultra-processed food if political parties are serious about improving mental health in future generations

Julia J Rucklidge, Roger T Mulder

There are good health reasons for making fruits and vegetables more affordable through removing GST. Fruit and vegetables are central to diets identified as being essential for optimising brain health, including protection from developing depression and anxiety as well as reducing the incidence of behavioural problems in children.

Article
Vol 136 No 1583: 6 October

Goals of care in the Wellington Emergency Department: a clinical audit

Jesse Cain, Brad Peckler, Sinéad Donnelly

New Zealand has an ageing population, where older people are living longer with more medical comorbidities. Many older people present to the emergency department (ED) and these presentations can be a sign of deterioration in overall health.

Article
Vol 136 No 1583: 6 October

Head and neck continued: a retrospective analysis of neck dissections from a New Zealand oral and maxillofacial surgery unit

Ellen OY Simpson, Alastair Luo, Jamie Mckenzie, Monish M Maharaj, Thasvir Singh

Cancers of the head and neck are among the most common cancers worldwide, totalling in excess of 900,000 cases annually.

Article
Vol 136 No 1583: 6 October

Cascade of care and rapid treatment pathway at Auckland City Hospital for patients with a new diagnosis of HIV infection, 2015–2019

Annabelle Donaldson, Michele Lowe, Simon Briggs

Early initiation of antiretroviral therapy (ART) has been shown to markedly reduce transmissions of HIV, and reduce mortality for people living with HIV (PLHIV) with health benefits occurring regardless of the initial CD4 count.

Article
Vol 136 No 1583: 6 October

Exploring health professionals’ viewpoint of provision of nutrition advice for women with endometrial cancer

Linda Williams, Claire Henry, Bryony Simcock, Sara Filoche

Endometrial cancer survivors have a higher incidence of unrecognised and inadequately treated hyperglycemia and elevated cholesterol, putting them at significantly higher 10-year increased risk of cardiovascular disease compared to women in the general population.

Article
Vol 136 No 1583: 6 October

A glimpse into the incidence and mortality of aortic dissection in Aotearoa New Zealand

Eric TA Lim, Adib Khanafer

Aortic dissection is considered an uncommon medical presentation, yet it is associated with high morbidity and mortality if not recognised.

Viewpoint
Vol 136 No 1583: 6 October

Connectivity for point-of-care testing results: a call for change

Samarina MA Musaad, Vanessa Buchan, Geoff Herd, on behalf of the NZ POCT AG

Connectivity for point-of-care testing (POCT) results helps ensure that clinicians have access to complete and accurate diagnostic information for decision making. It is the capability of a POCT device to link electronically with the laboratory, hospital information systems and patients’ permanent electronic medical record or general practice patient management systems.

Viewpoint
Vol 136 No 1583: 6 October

Continued mitigation needed to minimise the high health burden from COVID-19 in Aotearoa New Zealand

Michael G Baker, Amanda Kvalsvig, Michael J Plank, Jemma L Geoghegan, Teresa Wall, Collin Tukuitonga, Jennifer Summers, Julie Bennett, John Kerr, Nikki Turner, Sally Roberts, Kelvin Ward, Bryan Betty, Q Sue Huang, Nigel French, Nick Wilson

This viewpoint article reviews the past, current and potential continuing health impact of COVID-19 in Aotearoa New Zealand.

Clinical Correspondence
Vol 136 No 1583: 6 October

Watch that bite: syncope versus seizure

Tony Zhang

A referral was received from the emergency department for review of a middle-aged woman who presented with several months of recurrent unwitnessed “blackouts”. Upon direct questioning, the patient admitted to occasionally waking up after these events with a sore tongue and the taste of blood in her mouth.

Letter
Vol 136 No 1583: 6 October

Physician associates as a potential win for the Aotearoa New Zealand healthcare workforce

Victoria Oberzil

As of July 2023, a proposal to regulate the physician associate (PA) profession under the Health Practitioners Competence Assurance Act (HPCAA) has been put forth by Manatū Hauora – Ministry of Health.

Research Letter
Vol 136 No 1583: 6 October

A review of 19 years of anaphylaxis cross-reactivity data to muscle relaxants in New Zealand

Zyllan P Spilsbury, Han Truong

Anaphylaxis is “a severe, potentially fatal, systemic allergic reaction that occurs suddenly after contact with an allergy causing substance”.

100 Years Ago in the NZMJ
Vol 136 No 1583: 6 October

Medical Spiritual Healing.

NZMJ, 1923

The attitude of the medical profession as a body toward the Hickson Spiritual Healing Mission has been set forth by Dr. J. Hardie Neil, President of the Auckland Division of the New Zealand Branch of the British Medical Association, and as Dr. Neil’s opinion coincides with our own and is a fair presentation of the views commonly held by the medical profession, we think it advisable and opportune to place this aspect of the question before our readers.

Editorial
SUMMARY

The imperative to tax ultra-processed food if political parties are serious about improving mental health in future generations

Julia J Rucklidge, Roger T Mulder

There is now robust research highlighting the strong association between consumption of ultra-processed products (UPF) and poor mental health. The data are most concerning in pregnancy. The more UPF the mother eats and/or the less whole foods she eats, the greater the risk of her child developing mental health problems. Successive governments are silent on the dangers of UPF food on mental health. With rising numbers of people struggling with mental health problems alongside the crippling costs to health, we need forward and transformative initiatives to tackle this problem. Taxing UPFs would be one avenue to adjust the fiscal levers to sway more people to make healthier food choices.

Article
SUMMARY

Goals of care in the Wellington Emergency Department: a clinical audit

Jesse Cain, Brad Peckler, Sinéad Donnelly

New Zealand has an ageing population where many older persons present to the emergency department. There are many treatment options from curative to comfort-based care. Goals of care discussions explore treatment options with patients to formulate an appropriate care plan if they are to deteriorate. These discussions reduce aggressive treatment, hospitalisation, and cost to the healthcare system. We aim to determine how often goals of care are being discussed in the emergency department for older persons.

Article
SUMMARY

Head and neck continued: a retrospective analysis of neck dissections from a New Zealand oral and maxillofacial surgery unit

Ellen OY Simpson, Alastair Luo, Jamie Mckenzie, Monish M Maharaj, Thasvir Singh

The Oral and Maxillofacial Surgery (OMS) Unit at Waikato Hospital is one of the only OMS units in New Zealand to ablate oral cavity malignancies and reconstruct the defect with vascularised free flaps. This study’s aim was to retrospectively analyse the demographics, nodal yields and metastatic rates, and complications of patients that underwent a neck dissection within the OMS unit. The paper concluded that the OMS unit recommends omission of neck dissection levels IIb and IV in cN0 cases if deemed oncologically safe to do so.

Article
SUMMARY

Cascade of care and rapid treatment pathway at Auckland City Hospital for patients with a new diagnosis of HIV infection, 2015–2019

Annabelle Donaldson, Michele Lowe, Simon Briggs

Early initiation of antiretroviral therapy for people living with HIV has been shown to reduce transmission of HIV and improve health outcomes for people living with HIV. For people with newly diagnosed HIV referred to Auckland City hospital between 2015 and 2019, 197/200 (98.5%) were initiated on HIV treatment and of these 99% (195/197) had confirmed suppression of their virus. Policy changes in 2017 enabled a rapid treatment pathway to be established and this has led to a significant shortening of time from diagnosis to starting treatment. It is important that there is increased testing for HIV in New Zealand as there is effective treatment that keeps people well and prevents HIV transmission.

Article
SUMMARY

Exploring health professionals’ viewpoint of provision of nutrition advice for women with endometrial cancer

Linda Williams, Claire Henry, Bryony Simcock, Sara Filoche

Of the 20 most common cancers, endometrial cancer has the strongest association with high weight. Individuals who survive endometrial cancer are at high risk of experiencing morbidity and mortality from cardiovascular disease due to shared risk factors. This study explored access to nutrition advice as part of survivorship care through interviews with health professionals. How to navigate conversations about high weight, access to limited resourcing, and health professionals feeling powerless to overcome system influences were all identified as barriers. A supportive environment and community approach were identified as facilitating delivery and uptake of nutrition advice.

Article
SUMMARY

A glimpse into the incidence and mortality of aortic dissection in Aotearoa New Zealand

Eric TA Lim, Adib Khanafer

Aortic dissection is a lethal medical diagnosis resulting in a tear in the main blood vessel coming out from the heart, known as the aorta. Currently published studies worldwide are showing that there is a trend towards a global rise in the incidence of aortic dissection. Unfortunately, there is no nationally available study performed here in Aotearoa New Zealand. Our study is the first to nationally map out the incidence and deaths from aortic dissection. Our results are concordant and show a similar rise in the incidence of aortic dissection and a gradual decline in death rates from aortic dissection in Aotearoa New Zealand.

Viewpoint
SUMMARY

Connectivity for point-of-care testing results: a call for change

Samarina MA Musaad, Vanessa Buchan, Geoff Herd, on behalf of the NZ POCT AG

Every New Zealander has the right to a good standard of healthcare, and has the right, if chosen, to have their results available to their healthcare providers. If this right is given to some and not others, this creates an unfair health service. Point-of-care tests are tests done outside of the laboratory near the patient, for example, RAT tests for COVID-19 done at a pharmacy, or urine pregnancy tests done at home. Connecting point-of-care test results means that the results automatically get transferred electronically to the patient’s medical record. If the result of a point-of-care test does not get electronically transferred to the patient’s medical record it means that: • The healthcare provider may not know the test was done. • The healthcare provider will not be able to see the result. • If the result is recorded incorrectly, the healthcare provider will have a wrong result for their patient. All these situations mean that the healthcare provider may not have the correct information to make correct decisions, and so the patient or whānau may not get the best possible healthcare. This article is written to remind decision makers of the avoidable risks to the patient when point-of-care testing results are not electronically transferred, and that electronically transferring these results is no less important than transferring results from a laboratory.

Viewpoint
SUMMARY

Continued mitigation needed to minimise the high health burden from COVID-19 in Aotearoa New Zealand

Michael G Baker, Amanda Kvalsvig, Michael J Plank, Jemma L Geoghegan, Teresa Wall, Collin Tukuitonga, Jennifer Summers, Julie Bennett, John Kerr, Nikki Turner, Sally Roberts, Kelvin Ward, Bryan Betty, Q Sue Huang, Nigel French, Nick Wilson

The next phase of the COVID-19 pandemic response should integrate control of this disease into a comprehensive respiratory infectious disease mitigation strategy that also covers influenza and other serious respiratory infections. This combined approach would increase the effectiveness and efficiency of the response. This is the view of 16 leading New Zealand scientists and doctors who have worked actively on the pandemic response. They have written the most comprehensive summary of the pandemic published so far, covering the first three and half years. They note that the pandemic has not gone away and remains an important cause of illness, hospitalisation, long Covid and death (it is currently New Zealand’s number one infectious disease killer ahead of influenza), so needs a continuing, strong, evidence-based response. The authors conclude that New Zealand delivered amongst the best pandemic responses in the world, keeping cumulative excess deaths close to zero, and saving an estimated 20,000 lives compared with the mortality rate seen in countries like the United States. Remarkably, it did this using restrictions that were amongst the lowest used by high-income countries (the average stringency of control measures in New Zealand was less than in Sweden, for example). They hope that future Governments will build on this world-leading response which offers a high degree of health protection for severe future pandemics.

Clinical Correspondence
SUMMARY

Watch that bite: syncope versus seizure

Tony Zhang

This case portrays an exaggerated example of a relatively common clinical sign. A patient with repeated episodes of unexplained “blackouts” was referred for a second opinion on the aetiology. The major clinical clue on examination was the presence of lateral tongue biting, which is highly specific for “ruling in” seizures. The striking feature demonstrated in the image was the presence of accessory tongue tissue as a result of repeated tongue biting over the last few months.

Research Letter
SUMMARY

A review of 19 years of anaphylaxis cross-reactivity data to muscle relaxants in New Zealand

Zyllan P Spilsbury, Han Truong

We report the rates of anaphylaxis cross-reactivity of neuromuscular blocking agents (NMBA) for patients who have undergone skin testing after a confirmed allergic event in clinical practice. In cases of NMBA anaphylaxis, the index NMBA alone cannot be used to predict alternative NMBAs for safe future use and referral to a specialist anaesthetic allergy centre remains advised.

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