The New Zealand medical journal最新文献

{"title":"Infective endocarditis in patients with rheumatic heart disease: a single-centre retrospective comparative study.","authors":"Ammar Alsamarrai,&nbsp;Cathlyna Saavedra,&nbsp;Aliya Bryce,&nbsp;Eliazar Dimalapang,&nbsp;Alison Leversha,&nbsp;Simon Briggs,&nbsp;Nigel Wilson,&nbsp;Miriam Wheeler","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aims: </strong>We reviewed the baseline characteristics and outcomes of patients with infective endocarditis (IE) and compared those with and without rheumatic heart disease (RHD).</p><p><strong>Methods: </strong>We retrospectively reviewed patients ≥15 years with IE treated at Auckland City Hospital between January 2016 and December 2018 and excluded device-related IE and complex congenital heart disease. RHD status was based on echocardiographic features or previous history of rheumatic fever with valvular disease. Microbiologic and echocardiographic results, treatment modalities and complications were recorded. Demographics and outcomes were compared based on RHD status.</p><p><strong>Results: </strong>There were 155 patients with IE. Twenty-two had RHD. The mean age at admission was 45 years for RHD patients, which was 19 years younger than for non-RHD patients. There were significantly more Pacific patients with RHD (55% vs 14%). Previous IE and prosthetic valve endocarditis (PVE) were more common in RHD patients (27% vs 5%, and 77% vs 29%, respectively). After a median follow-up of 29 months, there was no significant difference in all-cause mortality between the two groups. However, 25/155 patients (16%) had died from IE-related causes (septic or cardiogenic shock post cardiac surgery, or embolic complications), with a significantly higher mortality in patients with RHD (7/22 (32%) patients, HR: 2.5) on univariate analysis. On multivariable analysis, PVE, heart failure, Staphylococcus aureus infection, diabetes, stroke and cardiac abscess were all associated with increased mortality, whereas RHD was not independently associated with increased mortality.</p><p><strong>Conclusions: </strong>In this retrospective single-centre audit, patients with RHD experienced IE at a younger age, had a higher incidence of prosthetic valve endocarditis and a prior history of IE. Although there was no difference in all-cause mortality, mortality in patients with RHD was almost exclusively secondary to complications of IE. This highlights the need for prevention strategies against endocarditis in the RHD population, including use of antibiotic prophylaxis¬, accessible dental health care and a high clinical suspicion for IE in RHD by healthcare providers.</p>","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":" ","pages":"62-73"},"PeriodicalIF":1.7,"publicationDate":"2022-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40141287","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":"Endoscopic submucosal dissection: the first reported experience from a New Zealand centre.","authors":"Cameron Kmw Schauer,&nbsp;Ratna Pandey,&nbsp;Yohei Minato,&nbsp;Takashi Muramoto,&nbsp;Ken Ohata,&nbsp;Imran Khan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>Endoscopic submucosal dissection (ESD) is internationally accepted as a minimally invasive procedure to treat early gastrointestinal cancers endoscopically. Uptake of this procedure in the West is limited. No published data are available in New Zealand. We aimed to evaluate outcomes of this procedure at North Shore Hospital, Auckland.</p><p><strong>Methods: </strong>Following an overseas fellowship training period, we prospectively collected clinical outcomes, complications and defined quality indicators for patients undergoing ESD referred following a multidisciplinary meeting.</p><p><strong>Results: </strong>Between January 2020 until July 2021, 29 ESD procedures were performed in 27 patients, including 14 gastric, five oesophageal and 10 colorectal cases. The mean age was 72 (standard deviation (SD) 10.6). The majority of cases (62%) were done under general anaesthesia. The median lesion size resected was 30mm (interquartile range (IQR) 20-58mm). The pre-endoscopic diagnosis was accurate as confirmed on final histology in 93% of cases. Thirty-four percent of lesions were T1 adenocarcinoma and completely resected. The median total duration of the procedure was 90 minutes (IQR 55-180). 86% of lesions were resected en-bloc. R0 resection was achieved in 72% of cases. All cases with R0 resection were curative except one. Muscular defects without perforation were seen and clipped at the time of endoscopy in 34% of cases. Two perforations were identified and sealed at the time of endoscopy. There were no cases of delayed bleeding, perforation or mortality.</p><p><strong>Conclusion: </strong>These data demonstrate clinical success, efficacy and safety of ESD at our centre. A larger study, comparison with other centres and longer clinical follow-up is required to confirm findings and further improve outcomes.</p>","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":" ","pages":"121-132"},"PeriodicalIF":1.7,"publicationDate":"2022-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40141269","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":"Characteristics of patients hospitalised with traumatic brain injuries.","authors":"Maria Bentley,&nbsp;Pragya Singhal,&nbsp;Grant Christey,&nbsp;Janet Amey","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the volume, injury characteristics and journey of Te Manawa Taki/Midland (TMT) residents hospitalised with a traumatic brain injury (TBI).</p><p><strong>Methods: </strong>A retrospective review of TMT Trauma Registry data between 1 January 2012 and 31 December 2019 was conducted. Eligible patients (n=4,875) were TMT residents hospitalised with an injury to the brain parenchyma.</p><p><strong>Results: </strong>An average 609 residents were hospitalised with a TBI diagnosis per year, increasing by an average of 7.0% annually. Males, Māori and 0-4- and 15-34-year-olds were proportionately over-represented. Transport incidents and falls were key mechanisms. Mild, moderate and severe TBI, derived by Abbreviated Injury Scale severity scores, were classified in 72.1%, 22.6% and 5.3% of patients, respectively. Concomitant injuries occurred in 78.1% of patients. Brain surgery was required by 3.5%, other surgery by 25.5% and intensive care by 14.9%, and 3.7% died. Mean length of hospitalisation was 5.8±9.3 days. There were 1,118 inter-facility transfers: 41.9% to designated out-of-region acute care and rehabilitation centres, an annual average of 59 TMT-domiciled patients.</p><p><strong>Conclusion: </strong>The increasing volume of diverse TBI hospitalisations represents a major burden on individuals, communities and health services. Effective strategies are needed to prevent injury and ensure treatment and rehabilitation are equitable and patient focused.</p>","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":" ","pages":"111-120"},"PeriodicalIF":1.7,"publicationDate":"2022-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40141268","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":"Cardiac magnetic resonance imaging can identify a diagnosis in suspected myocardial infarction with non-obstructive coronary arteries: illustrative case presentations.","authors":"Danting Wei,&nbsp;Mansi Turaga,&nbsp;Peter Barr,&nbsp;Ruvin Gabriel,&nbsp;Jen-Li Looi","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":" ","pages":"157-161"},"PeriodicalIF":1.7,"publicationDate":"2022-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40141272","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":"An evaluation of mandatory bicycle helmet legislation.","authors":"Rahul Makam","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":" ","pages":"140-146"},"PeriodicalIF":1.7,"publicationDate":"2022-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40141270","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":"Choosing Wisely: the lack of validity of ultrasound scans in the investigation of shoulder instability.","authors":"C. Oorschot, K. Mohammed, Michael Austen, Emma O’Loughlin, Joanna Spillane","doi":"10.1302/1358-992x.2023.2.120","DOIUrl":"https://doi.org/10.1302/1358-992x.2023.2.120","url":null,"abstract":"AIM\u0000To test the clinical validity and financial implications of the proposed Choosing Wisely statement: \"Using ultrasound as a screening test for shoulder instability is inappropriate in people under 30 years of age, unless there is clinical suspicion of a rotator cuff tear.\"\u0000\u0000\u0000METHOD\u0000A retrospective chart review from a specialist shoulder surgeon's practice over a two-year period recorded 124 patients under the age of 30 referred with shoulder instability. Of these, forty-one had already had ultrasound scans performed prior to specialist review. The scan results and patient files were reviewed to determine the reported findings on the scans and whether these findings were clinically relevant to diagnosis and decision-making. Comparison was made with subsequent MRI scan results. The data, obtained from the Accident Compensation Corporation (ACC), recorded the number of cases and costs incurred for ultrasound scans of the shoulder in patients under 30 years old over a 10-year period.\u0000\u0000\u0000RESULTS\u0000There were no cases where the ultrasound scan was considered useful in decision-making. No patient had a full thickness rotator cuff tear. Thirty-nine of the 41 patients subsequently had MRI scans. The cost to the ACC for funding ultrasound scans in patients under 30 has increased over the last decade and exceeded one million dollars in the 2020/2021 financial year. In addition, patients pay a surcharge for this test.\u0000\u0000\u0000CONCLUSION\u0000The proposed Choosing Wisely statement is valid. This evidence supports that ultrasound is an unnecessary investigation for patients with shoulder instability unless there is clinical suspicion of a rotator cuff tear. Ultrasound also incurs costs to the insurer (ACC) and the patient. We recommend x-rays and, if further imaging is indicated, High Tech Imaging with MRI and sometimes CT scans in these patients.","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125967089","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":"Health expenditure.","authors":"J. Hamer, M. Beard","doi":"10.1787/soc_aag-2014-graph45-en","DOIUrl":"https://doi.org/10.1787/soc_aag-2014-graph45-en","url":null,"abstract":"","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126633357","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 Persistence of Neutralising Antibodies up to 11 months after SARS-CoV-2 Infection in the Southern Region of New Zealand","authors":"R. McGregor, Alyson Craigie, Susan J. Jack, A. Upton, N. Moreland, James E. Ussher","doi":"10.1101/2021.10.26.21265501","DOIUrl":"https://doi.org/10.1101/2021.10.26.21265501","url":null,"abstract":"During the first wave of SARS-CoV-2 infection in New Zealand a cohort of 78 PCR-confirmed COVID-19 cases was recruited in the Southern District Health Board region. Here we report on this unique cohort nearly 1-year after infection. There was no known community transmission in the region over the study period due to New Zealands elimination status at the time, nor had any participants received a COVID-19 vaccine. In the absence of re exposure, antibody reactivity to the viral spike protein, as well as neutralising antibodies to both the ancestral strain and the delta variant remained relatively stable between 8 and 11 months post-infection. This suggests long-lived antibody responses can be generated from a single natural infection event. However, given the risks of serious disease associated with SARS-CoV-2 infection, vaccination is still strongly recommended.","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116435664","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 End of Life Choice Act: a proposed implementation and research agenda.","authors":"Jessica Young, J. Winters, J. Snelling, B. White, C. Gavaghan, A. Geddis, R. Egan","doi":"10.2139/ssrn.3969548","DOIUrl":"https://doi.org/10.2139/ssrn.3969548","url":null,"abstract":"AIM\u0000This article outlines the End of Life Choice Act 2019. It highlights some of the key implementation issues to ensure the system operates safely and equitably after the Act comes into force. It also identifies priorities for research to ensure issues are detected and provision of assisted dying (AD) is monitored.\u0000\u0000\u0000METHOD\u0000We reviewed the End of Life Choice Act, assisted dying implementation literature and governmental reports.\u0000\u0000\u0000RESULTS\u0000Effective system implementation depends on infrastructure, oversight and funding. In terms of service provision, we make recommendations about training for all health practitioners and providing practitioners; the nuances of discussing the \"wish to hasten death\"; conscientious objection; cultural safety for Māori; and minimising the complexity of delivering assisted dying practice. Structured research is needed to understand how the assisted dying system is operating.\u0000\u0000\u0000CONCLUSION\u0000This article contributes by identifying core issues for practitioners, patients and policymakers. Implementation is an ongoing process that continues after the Act starts. Data are required to know whether access is equitable, who is choosing to make use of the law, whether providers are well informed and whether the safeguards are working as intended. The implications of how the Act is implemented are significant for patients, whānau, health professionals and society.","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127322183","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":"Defining rural in Aotearoa New Zealand: a novel geographic classification for health purposes.","authors":"Jesse Whitehead, G. Davie, B. de Graaf, S. Crengle, D. Fearnley, Michelle Smith, R. Lawrenson, Garry Nixon","doi":"10.21203/rs.3.rs-817117/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-817117/v1","url":null,"abstract":"AIM\u0000Describe the first specifically designed and validated five-level rurality classification for health purposes in New Zealand that is both data-driven and incorporates heuristic understandings of rurality.\u0000\u0000\u0000METHOD\u0000Our approach involved: (1) defining the purpose and parameters of a proposed five-level Geographic Classification for Health (GCH); (2) developing a quantitative framework; (3) undertaking co-design with the National Rural Health Advisory Group (NRHAG), and extensive consultation with key stakeholders; (4) testing the validity of the five-level GCH and comparing it to previous Statistics New Zealand (Stats NZ) rurality classifications; and (5) describing rural populations and identifying differences in all-cause mortality using the GCH and previous Stats NZ rurality classifications.\u0000\u0000\u0000RESULTS\u0000The GCH is a technically robust and heuristically valid rurality classification for health purposes. It identifies a rural population that is different to the population defined by generic Stats NZ classifications. When applied to New Zealand's Mortality Collection, the GCH estimates a rural mortality rate 21% higher than for residents of urban areas. These rural-urban disparities are masked by the generic Stats NZ classifications.\u0000\u0000\u0000CONCLUSION\u0000The development of the five-level GCH embraces both the technical and heuristic aspects of rurality. The GCH offers the opportunity to develop a body of New Zealand rural health literature founded on a robust conceptualisation of rurality.","PeriodicalId":160836,"journal":{"name":"The New Zealand medical journal","volume":"105 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132176573","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}