The New Zealand medical journal最新文献

{"title":"Should paediatric tonsillar asymmetry be an indication for tonsillectomy? A single centre experience.","authors":"Georgia Mackay, Alina Rankin, S. Meghji, Craig McCaffer","doi":"10.26635/6965.6386","DOIUrl":"https://doi.org/10.26635/6965.6386","url":null,"abstract":"BACKGROUND\u0000Paediatric tonsillar lymphoma (TL) is a rare diagnosis. Historically, the presence of clinical features such as tonsillar asymmetry, grossly abnormal tonsil appearance and cervical lymphadenopathy raise concern for this diagnosis. Tonsillar asymmetry is considered to be the most concerning clinical feature; however, asymmetry is often apparent due to differences in depth or shape of tonsillar fossa and tonsillar pillars, rather than a true difference in volume. There is debate whether a tonsillectomy is required in all cases of tonsil asymmetry to exclude lymphoma, and what clinical features should raise concern. The aim of this study was to establish whether the presence of clinical asymmetry can be deemed a reliable marker for genuine tonsil size discrepancies. We also sought to evaluate the clinical and examination characteristics that are concerning for lymphoma.\u0000\u0000\u0000METHODS\u0000Retrospective review of clinical records for paediatric tonsil specimens sent for histological evaluation between 1 January 2012 and 1 January 2023 driven by a clinical suspicion of lymphoma at Starship Children's Hospital, New Zealand. Patient demographics and clinical data were recorded. A comparison was made between tonsil size asymmetry on clinical examination (Brodsky criteria) and tonsil volume difference based on dimensions given in pathology reports.\u0000\u0000\u0000RESULTS\u0000One hundred and forty-three patients had tonsillectomies between 2012 and 2022 at Starship Children's Hospital due to concern for lymphoma. Of these, three were positive for lymphoma. Presence of pain and abnormal tonsil appearance were predictors for lymphoma (p<0.02). Interrater reliability agreement between clinical size difference and tonsil volume was poor, Kappa= -0.13 p<0.05.\u0000\u0000\u0000CONCLUSION\u0000Clinical size difference is a poor predictor for true tonsil volume difference. We advise that assessment of tonsil size should be performed in conjunction with the examination of gross visual abnormalities and lymphadenopathy to guide clinical decision making.","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":"21 5","pages":"68-74"},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140710955","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}

{"title":"The simple gallbladder with a twist?","authors":"Neeraj Khatri, Ahmed Abdile, Fraser Welsh, Nicholas Smith","doi":"10.26635/6965.6366","DOIUrl":"https://doi.org/10.26635/6965.6366","url":null,"abstract":"","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":"1 1‐2","pages":"81-84"},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140712222","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}

{"title":"Alcohol-associated liver disease and the COVID-19 pandemic in New Zealand-a single centre retrospective analysis.","authors":"Kevin Yy Chen, M. Wang, Cameron Schauer","doi":"10.26635/6965.6471","DOIUrl":"https://doi.org/10.26635/6965.6471","url":null,"abstract":"","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":"7 6","pages":"99-104"},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140710609","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}

{"title":"Perspectives of potentially eligible Indigenous Māori on a lung cancer screening programme: a qualitative study.","authors":"S. Colhoun, Kate Parker, S. McCook, Karen Bartholomew, Billie Baty, Anna Maxwell, Kataraina Pipi, Maria Marama, Sue Crengle","doi":"10.26635/6965.6335","DOIUrl":"https://doi.org/10.26635/6965.6335","url":null,"abstract":"AIMS\u0000Lung cancer causes more deaths than any other cancer, globally and in Aotearoa New Zealand, where it disproportionately affects Māori. We aimed to understand Māori perspectives on lung cancer screening in Aotearoa New Zealand to guide its equity-focussed implementation, including identifying enablers and barriers.\u0000\u0000\u0000METHODS\u0000We took a Kaupapa Māori based co-design approach to inform future screening, recruiting Māori current/ex-smokers and members of their whānau (family) for three focus group phases held in Auckland, Aotearoa New Zealand in August 2019. Participants responded to a proposed lung cancer screening pathway and shared their attitudes and beliefs about lung cancer and screening. Results were thematically analysed.\u0000\u0000\u0000RESULTS\u0000The 21 Māori participants supported future lung cancer screening in Aotearoa New Zealand. Perceived benefits included being more informed about lung cancer and screening and enabling healthier future generations. Barriers to screening were previous negative health service experiences; fear; stigma; and access, including time, cost and transport. Enablers included providers' cultural competence; clear communication; a one-stop shop; and support with transport. A range of factors could potentially influence a decision to participate in screening.\u0000\u0000\u0000CONCLUSIONS\u0000Participants favoured future lung cancer screening and identified key barriers and facilitators of screening.","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":"18 49","pages":"45-55"},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140711720","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}

{"title":"Changing the script: medicine optimisation recommendations made during proactive multidisciplinary meetings with older adults.","authors":"K. Bloomfield, J. Hikaka, Julia Brookes, A. Tatton, C. Calvert, Zhenqiang Wu, Michal Boyd, Kathy Peri, Dale Bramley, Martin Connolly","doi":"10.26635/6965.6443","DOIUrl":"https://doi.org/10.26635/6965.6443","url":null,"abstract":"","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":"54 1","pages":"96-98"},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140710891","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}

{"title":"Exploring training, involvement and confidence: a study of healthcare professionals in decision-making capacity assessments.","authors":"Nicola Hickling, Clare McCann, L. Tippett, Gary Cheung","doi":"10.26635/6965.6299","DOIUrl":"https://doi.org/10.26635/6965.6299","url":null,"abstract":"AIM\u0000To explore the training, involvement and confidence of healthcare professionals involved in decision-making capacity (DMC) assessments, and to compare any differences between those conducting and those involved in, but not conducting DMC assessments.\u0000\u0000\u0000METHOD\u0000A 10-minute anonymous, online survey was conducted with both closed and open questions. A total of 78 participants completed the survey.\u0000\u0000\u0000RESULTS\u0000Training was lacking in quantity and adequacy. Only 14.1% received formal training during and post their qualification and only 38.5% reported the right amount of training. Just over 55% reported having the right amount of involvement, with 18% having too much and 27% having not enough involvement. A significantly higher response was given for having too much involvement by those conducting DMC assessments (p=0.006), while those not conducting felt they do not have enough involvement (p<0.001). Only 25.6% (n=20) were very confident in being able to explain DMC to a patient.\u0000\u0000\u0000CONCLUSIONS\u0000Healthcare professionals working in this area urgently require support in the form of formal training and defined roles. Given what can be at stake for an individual undergoing a DMC assessment, it is imperative that improvements are made to upskill the workforce and utilise expertise of all healthcare professionals.","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":"6 6","pages":"31-44"},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140712236","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}

{"title":"Recreational ketamine use can lead to irreversible bladder damage.","authors":"Daniel Eaton, Frank Kueppers","doi":"10.26635/6965.6357","DOIUrl":"https://doi.org/10.26635/6965.6357","url":null,"abstract":"An increasing number of young patients with severe bladder overactivity syndrome potentially caused by recreational ketamine use has been treated in our department. Ketamine has become a popular and increasingly used recreational drug in New Zealand. Ketamine bladder syndrome has been reported internationally; however, local New Zealand data do not exist. It can lead to irreversible damage to the bladder, and internationally, surgical procedures like cystectomy and urinary diversion or augmentation cystoplasty have been reported as necessary treatments.","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":"58 6","pages":"85-89"},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140709711","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}

{"title":"Re: Epidemiology of giant cell arteritis in Waikato, Aotearoa New Zealand.","authors":"V. Modesto dos Santos, Taciana Arruda Modesto Sugai","doi":"10.26635/6965.6568","DOIUrl":"https://doi.org/10.26635/6965.6568","url":null,"abstract":"The interest in epidemiological data on giant cell arteritis (GCA) increased both in New Zealand and in Latin America, resulting in updated articles like those here commented. Of more relevance are two very recent contributions by van Dantzig et al. with novel conclusive findings from their evaluations on GCA performed in the region of Waikato. The authors emphasised that the diagnosis of GCA remained stable in this region from 2014 to 2022, being uncommon among Māori, Pacific peoples and Asian ethnic groups. Short comments on some literature data from Argentina, Brazil, Colombia, Peru and Mexico about the systemic arteritis are here addressed to show the Latin American view. The authors strongly believe that this kind of report may enhance the general interest on diagnostic and management issues related to this very important systemic vasculitis.","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":"75 9","pages":"93-95"},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140709335","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}

{"title":"Changes in alcohol-related emergency department presentations-a comparison of three waves in 2013, 2017 and 2022.","authors":"Laura Joyce, Lana Cleland, Elise Forman, Alex Hlavac, James Foulds, Rose Crossin","doi":"10.26635/6965.6375","DOIUrl":"https://doi.org/10.26635/6965.6375","url":null,"abstract":"AIMS\u0000Emergency departments (EDs) around the world are increasingly overcrowded, which is associated with significant patient harm. Alcohol use is a known contributor to ED overcrowding. This study aimed to assess trends in the characteristics of alcohol-related ED presentations over time.\u0000\u0000\u0000METHODS\u0000A cross-sectional observational study of Christchurch ED attendances during 3-week waves of data collection in November-December 2013, 2017 and 2022 was conducted. Potential participants were those patients attending the Christchurch Hospital ED who had ingested alcohol in the 4 hours prior to arrival, and/or the presentation was thought to be related to alcohol. Those who consented to take part were interviewed to examine amount and source of alcohol.\u0000\u0000\u0000RESULTS\u0000There has been a change in the age profile towards a greater proportion of older patients attending the ED with alcohol-related issues. In 2022, a greater proportion of alcohol was purchased from on-licence venues compared to previous years, although off-licence alcohol purchase and consumption in private locations remained the most common.\u0000\u0000\u0000CONCLUSION\u0000Alcohol use and harm places a significant, yet preventable, burden on EDs and the wider healthcare system. Implementation of evidence-based alcohol policies is urgently needed to reduce the impact of alcohol in the ED and improve the health of communities.","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":"8 10","pages":"56-67"},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140710079","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}

{"title":"Intensive management from diagnosis improves HbA1c at 12 months post-diagnosis: results from a prospective cohort study in children with newly diagnosed type 1 diabetes.","authors":"Caroline Griffin, Erin Roxburgh, Neil Owens, Olivia Sanders, Sharon Walsh, Chloe Hudson, Janet Ferguson, Karen MacKenzie, Martin de Bock","doi":"10.26635/6965.6424","DOIUrl":"https://doi.org/10.26635/6965.6424","url":null,"abstract":"AIMS\u0000To examine the impact of intensive management of type 1 diabetes (T1D) from diagnosis on HbA1c 12 months from diagnosis.\u0000\u0000\u0000METHODS\u0000HbA1c measured 12 months after diagnosis for 70 consecutively newly diagnosed children with T1D following implementation of an intensive management protocol was compared with 70 children consecutively diagnosed immediately pre-implementation. Intensive management involved carbohydrate counting and flexible insulin dosing from first meal with subcutaneous insulin, targeted blood glucose levels from 4-8mmol/L irrespective of time of day, avoidance of twice daily insulin regimen and promotion of continuous glucose monitoring (CGM). HbA1c, diabetes technology use and insulin regimen at 12 months post-diagnosis were compared.\u0000\u0000\u0000RESULTS\u0000The post-intensive management implementation cohort had an improved mean HbA1c of 58.2±15.3mmol/mol vs 63.7±10.7mmol/mol at 12 months (p=0.014). The proportion of young people with diabetes meeting a target HbA1c of <53mmol/mol at 12 months improved from 11% to 40% (p=<0.001). There was a reduction of twice daily insulin regimen from 66% to 11% (p=<0.001), and increased CGM use from 57% to 76% (p=0.02).\u0000\u0000\u0000CONCLUSION\u0000Intensive management when implemented with consistent messaging from the multi-disciplinary team resulted in clinic-wide improvements in HbA1c and the proportion meeting HbA1c targets.","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":"26 36","pages":"14-30"},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140711685","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}