The New Zealand medical journal最新文献

Outcomes of asymptomatic common bile duct stones detected at intraoperative cholangiography. 术中胆管造影检查发现的无症状胆总管结石的治疗效果。

The New Zealand medical journal Pub Date : 2024-05-17 DOI: 10.26635/6965.6491

X. Field, Chelsea Tong, Sarah Cox, James Crichton, Bernadette Goodwin, Fraser Welsh, Ryan Cha

{"title":"Outcomes of asymptomatic common bile duct stones detected at intraoperative cholangiography.","authors":"X. Field, Chelsea Tong, Sarah Cox, James Crichton, Bernadette Goodwin, Fraser Welsh, Ryan Cha","doi":"10.26635/6965.6491","DOIUrl":"https://doi.org/10.26635/6965.6491","url":null,"abstract":"AIMS\u0000The aim of this study was to investigate the outcome of common bile duct stones (CBDS) in asymptomatic patients at laparoscopic cholecystectomy (LC) and intra-operative cholangiogram (IOC).\u0000\u0000\u0000METHODS\u0000All patients undergoing LC and IOC at Te Whatu Ora - Health New Zealand Waikato between January 2017 and January 2022 were retrospectively reviewed. Electronic records were screened for asymptomatic CBDS. Exclusion criteria were hyperbilirubinaemia, gallstone pancreatitis, cholangitis and imaging-detected CBDS. IOC reports were reviewed to determine presence of CBDS. A second blinded review was undertaken by a radiologist. Outcomes were use of endoscopic retrograde pancreatography (ERCP), complications and readmission with retained CBDS.\u0000\u0000\u0000RESULTS\u0000Included were 1,297 patients undergoing LC and IOC. Of these, 150 (24.1%) patients had a positive IOC, of which 58 (38.7%) were asymptomatic. Attempted flushing of CBDS was employed in 49 cases, 10 successfully. Common duct exploration was successful in a further six out of seven cases. Of the remaining 42 patients, 18 were offered ERCP. Seven had no stone at endoscopy. Sixteen had imaging, revealing clear ducts in 14. The remaining two then had ERCP confirming choledocholithiasis. Eight patients were managed expectantly, of whom none required readmission with retained stones.\u0000\u0000\u0000CONCLUSION\u0000Rates of retained asymptomatic stones after positive IOC were low. Acknowledging risks associated with intervention and low rates of readmission with retained CBDS, an expectant approach could be more readily considered.","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":"56 26","pages":"73-79"},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140965748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Guideline versus clinician recommended duration of dual antiplatelet therapy following acute coronary syndrome (ANZACS-QI 78). 急性冠状动脉综合征（ANZACS-QI 78）后双联抗血小板疗法的指南与临床医生推荐的持续时间。

The New Zealand medical journal Pub Date : 2024-05-17 DOI: 10.26635/6965.6437

Sophie J Rees, Andrew J Kerr

{"title":"Guideline versus clinician recommended duration of dual antiplatelet therapy following acute coronary syndrome (ANZACS-QI 78).","authors":"Sophie J Rees, Andrew J Kerr","doi":"10.26635/6965.6437","DOIUrl":"https://doi.org/10.26635/6965.6437","url":null,"abstract":"AIM\u0000The recommended duration of dual anti-platelet therapy (DAPT) following acute coronary syndrome (ACS) for patients without atrial fibrillation varies from 1 month to 1 year depending on the balance of risks of ischaemia and major bleeding. Patients on DAPT with a high risk of gastrointestinal bleeding are also recommended to receive a proton pump inhibitor (PPI). Our aim was to audit current practice against the 2020 European Society of Cardiology (ESC) guideline recommendations.\u0000\u0000\u0000METHODS\u0000One hundred consecutive ACS patients treated with percutaneous coronary intervention discharged from Middlemore Hospital and without atrial fibrillation in the first quarter of 2023 were studied. ANZACS-QI ischaemic (I) and bleeding (B) risk scores were calculated, with patients categorised in four groups based on ESC recommendations-low I/low B risk, low I/high B, high I/low B and high I/high B. Guideline and clinician recommended duration of DAPT and prescription of PPI were compared.\u0000\u0000\u0000RESULTS\u0000All patients were planned for DAPT at discharge and 91% a PPI. Up to four out of five ACS patients could have been planned for shorter DAPT durations based on the ESC guideline recommendations. Over half of included patients (53%) had a high bleeding risk, yet 85% of these patients received 12 months of DAPT despite ESC recommendations of 1-3 months.\u0000\u0000\u0000CONCLUSIONS\u0000There was a divergence between clinical practice and the recommendations of the 2020 ESC guidelines. We discuss these results in relation to the updated August 2023 ESC guidelines, which have reaffirmed a 12-month duration of DAPT as the default position.","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":"5 12","pages":"64-72"},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140963675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Management of early dysglycaemia in pregnancy varies by region in Aotearoa New Zealand with risks of widening inequities. 在新西兰奥特亚罗瓦地区，对妊娠早期血糖异常的管理因地区而异，存在不公平现象扩大的风险。

The New Zealand medical journal Pub Date : 2024-05-17 DOI: 10.26635/6965.6540

Rosemary M Hall, Ruth Ce Hughes, Elizabeth Lewis-Hills, Janet A Rowan

引用次数: 0

Pae Ora (Disestablishment of Māori Health Authority) Amendment Act 2024: further Crown breaches of Te Tiriti o Waitangi. Pae Ora（解散毛利卫生局）2024 年修正法：政府进一步违反 Te Tiriti o Waitangi。

The New Zealand medical journal Pub Date : 2024-05-17 DOI: 10.26635/6965.6554

H. Came, Clive Aspin, Nicole Coupe, Timothy McCreanor

引用次数: 0

Good news about melanoma. 关于黑色素瘤的好消息

The New Zealand medical journal Pub Date : 2024-05-17 DOI: 10.26635/6965.e1595

Mark Elwood, Marius Rademaker

引用次数: 0

Increasing access to cataract surgery in Counties Manukau by optimising the clinical pathway: a quality improvement report. 通过优化临床路径提高马努考郡白内障手术的可及性：质量改进报告。

The New Zealand medical journal Pub Date : 2024-05-17 DOI: 10.26635/6965.6398

Manlio Chiesa, Graham Reeves, Courtney Harper, Mary Seddon, Valerio Malez

{"title":"Increasing access to cataract surgery in Counties Manukau by optimising the clinical pathway: a quality improvement report.","authors":"Manlio Chiesa, Graham Reeves, Courtney Harper, Mary Seddon, Valerio Malez","doi":"10.26635/6965.6398","DOIUrl":"https://doi.org/10.26635/6965.6398","url":null,"abstract":"AIM\u0000To streamline the cataract surgery pathway to improve the time from first specialist assessment (FSA) to surgery, while reducing the clinical priority assessment criteria (CPAC) score from 55 to 50.\u0000\u0000\u0000METHOD\u0000A quality improvement project using Lean Six Sigma tools and the Model for Improvement. Most data were collected from the i.Patient Manager (iPM) system and analysed using statistical process control charts. Change interventions included combining FSA and pre-admission clinics (PAC); post-operative telephone review by non senior medical officers (SMO); and using our own surgeons in private theatres.\u0000\u0000\u0000RESULTS\u0000The standard cataract pathway was reduced from 5 to 3 appointments. This removed 1,514 hours of appointments, released 113 SMO hours and saved patients NZ$156,000 in indirect costs over a year. The average waiting time from FSA to surgery decreased from 90 to 77 days (-13.5%). The number of overdue patients reduced from 127 to 44 (-35%). The average number of patients on the FSA waiting list dropped from 322 to 205 (-40%). There was no change to the proportions of surgeries or appointment attendance rates by ethnicity. Average monthly cataract surgeries increased from 192 to 215 (+12%), and the CPAC score threshold was decreased to 50 in February 2021.\u0000\u0000\u0000CONCLUSION\u0000Despite significant demand pressures, and the disruptions of COVID-19, we were able to reduce the CPAC score for accessing cataract surgery by optimising the clinical pathway to better utilise staff capacity and maximise value for patients.","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":"2 4","pages":"39-47"},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140961959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A case report of successful dual external defibrillation in cardiac arrest. 心脏骤停时成功进行双体外除颤的病例报告。

The New Zealand medical journal Pub Date : 2024-05-17 DOI: 10.26635/6965.6479

Anna G Bergin, C. C. Blackburn, Eric Chong, Ankur Gupta

引用次数: 0

An act of desperation: self-attempted gender-affirming mastectomy. 无奈之举：自我尝试确认性别的乳房切除术。

The New Zealand medical journal Pub Date : 2024-05-17 DOI: 10.26635/6965.6425

Mairarangi Haimona, Sue Hui Ong, Scott Diamond

引用次数: 0

Consequences of cost barriers to prescriptions: cohort study in Aotearoa New Zealand. 处方费用障碍的后果：新西兰奥特亚罗瓦的队列研究。

The New Zealand medical journal Pub Date : 2024-05-17 DOI: 10.26635/6965.6431

Mona Jeffreys, M. Pledger, Fiona McKenzie, L. Ellison-Loschmann, Maite Irurzun Lopez, Jacqueline Cumming

{"title":"Consequences of cost barriers to prescriptions: cohort study in Aotearoa New Zealand.","authors":"Mona Jeffreys, M. Pledger, Fiona McKenzie, L. Ellison-Loschmann, Maite Irurzun Lopez, Jacqueline Cumming","doi":"10.26635/6965.6431","DOIUrl":"https://doi.org/10.26635/6965.6431","url":null,"abstract":"AIMS\u0000A NZ$5 co-payment prescription charge was removed in July 2023 but may be reinstated. Here we quantify the health impact and cost of not being able to afford this charge.\u0000\u0000\u0000METHODS\u0000We linked New Zealand Health Surveys (2013/2014-2018/2019) to hospitalisation data using data available in Integrated Data Infrastructure (IDI). Cox proportional-hazards models compared time to hospitalisation between those who had faced a cost barrier to collecting a prescription and those who had not.\u0000\u0000\u0000RESULTS\u0000Of the 81,626 total survey respondents, 72,243 were available for analysis in IDI. A further 516 were excluded to give an analysis dataset of 71,502. Of these, 5,889 (8.2%) reported not collecting a prescription due to cost in the previous year. Among people who faced a cost barrier, 60.0% (95% confidence interval [CI] 58.7-61.2%) were admitted to hospital during the study period, compared to 43.9% (95% CI 43.6-44.3%) of those who did not. Having adjusted for socio-demographic variables, people who faced a cost barrier were 34% (hazard ratio 1.34; 95% CI 1.29-1.39) more likely to be admitted to hospital than those who did not. Annual avoidable hospitalisation costs-were prescription co-payments to remain free-are estimated at $32.4 million per year based on the assumption of a causal relationship between unmet need for prescription medicines and subsequent hospitalisation.\u0000\u0000\u0000CONCLUSIONS\u0000The revenue to the health system from co-payments may be offset by the costs associated with avoidable hospitalisations.","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":"50 20","pages":"48-63"},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140965684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Construction of the chronic temporomandibular disorder patients: the association between neural and psychological pathways. 慢性颞下颌关节紊乱症患者的构建：神经与心理路径之间的关联。

The New Zealand medical journal Pub Date : 2024-05-17 DOI: 10.26635/6965.6513

A. Polonowita, Athula K Polonowita, Li Mei, G. Guan

{"title":"Construction of the chronic temporomandibular disorder patients: the association between neural and psychological pathways.","authors":"A. Polonowita, Athula K Polonowita, Li Mei, G. Guan","doi":"10.26635/6965.6513","DOIUrl":"https://doi.org/10.26635/6965.6513","url":null,"abstract":"Chronic temporomandibular disorder (cTMD) as a term based on the diagnostic criteria for temporomandibular disorders (DC/TMD) classification refers, in this paper, to the condition listed that has a non-mechanical association without any obvious organic cause. Specifically, this is the condition that falls under the International Classification of Diseases 11th revision (ICD-11) classification of chronic primary and chronic secondary pains. This implies that there is increased responsiveness of nociceptive neurons in the central nervous system, a phenomenon known as central sensitisation. cTMD patients may have their beginning with genetic susceptibility to pain. Although no single gene is exclusively linked to cTMD, various genes associated with nervous and musculoskeletal systems are believed to play a role. Environmental triggers and epigenetic changes are also thought to contribute to cTMD development. The biopsychosocial model emphasises the need to comprehensively address biological, psychological and social factors in cTMD assessment and management. In this study, we leverage the cyclic causation framework within the biopsychosocial model to illuminate the intricate interplay between biological and psychosocial factors in the context of cTMD. The conceptualisation of cTMD involves the dynamic evolution of genetic predispositions, influenced by life events and other biological susceptibilities. These factors collectively contribute to the emergence of nociplastic changes, ultimately manifesting as the distinctive features observed in individuals afflicted with cTMD.","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":"17 4","pages":"80-93"},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140965310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0