NEW ZEALAND MEDICAL JOURNAL最新文献_第10页

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。

IF 1.7

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: The 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.Methods: One 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.Results: All 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.Conclusions: There 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":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140959791","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

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。

IF 1.7

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: To 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.Method: A 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.Results: The 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.Conclusion: Despite 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":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140959794","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

Medication use before and after bariatric surgery: 5-year results from a randomised controlled trial of banded Roux-en-Y gastric bypass versus sleeve gastrectomy in patients with obesity and type 2 diabetes. 减肥手术前后的用药情况：针对肥胖和 2 型糖尿病患者的带状 Roux-en-Y 胃旁路术与袖带胃切除术随机对照试验的 5 年结果。

IF 1.7

NEW ZEALAND MEDICAL JOURNAL Pub Date : 2024-05-03 DOI: 10.26635/6965.6442

James Tan, Talat Nur, Bronwen Jones, Rinki Murphy, David Kim, Richard Cutfield, Lindsay D Plank, Michael Booth

{"title":"Medication use before and after bariatric surgery: 5-year results from a randomised controlled trial of banded Roux-en-Y gastric bypass versus sleeve gastrectomy in patients with obesity and type 2 diabetes.","authors":"James Tan, Talat Nur, Bronwen Jones, Rinki Murphy, David Kim, Richard Cutfield, Lindsay D Plank, Michael Booth","doi":"10.26635/6965.6442","DOIUrl":"10.26635/6965.6442","url":null,"abstract":"Aim: Bariatric surgery is an effective tool for weight loss and for improving weight related co-morbidities. Changes in medication usage after a silastic ring laparoscopic Roux-en-Y gastric bypass (SR-LRYGB) compared with laparoscopic sleeve gastrectomy (LSG) are unknown.Methods: This was a single-centre, double-blind, randomised controlled trial. Patients were randomised to either SR-LRYGB or LSG. A medication history was obtained at regular follow-up intervals, and mean numbers of prescribed medications were analysed over 5 years. Poisson regression and generalised estimating equations were used to test for statistically significant changes in usage.Results: After eight patients were lost to follow-up, data from 52 patients in each group were available for analysis. There was no difference between the SR-LRYGB or LSG groups in the number of medications prescribed, with the exception of oral glucose-lowering medications, where there was a greater decrease after SR-LRYGB compared to LSG (79% vs 55% respectively) from baseline to 5 years. At 5 years, total medication prescribed was down 10% from pre-operative levels. Prescribed insulin decreased by 72%, and cardiovascular medication decreased by 56% compared to baseline. Prescriptions for analgesia increased by 50%, psychiatric medications by 133% and proton-pump inhibitors by 81%.Conclusion: Both SR-LRYGB and LSG reduced requirement for diabetic and cardiovascular medications, but increased requirement for nutritional supplementation, analgesia and psychiatric medications. There was a greater reduction in oral anti-diabetic medication prescriptions following SR-LRYGB compared to LSG, but no other difference in medication usage between surgical groups was found.","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866999","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

Dispensing of attention-deficit hyperactivity disorder medications for adults in Aotearoa New Zealand. 新西兰奥特亚罗瓦成人注意缺陷多动障碍药物配发情况。

IF 1.2

NEW ZEALAND MEDICAL JOURNAL Pub Date : 2024-05-03 DOI: 10.26635/6965.6392

Ben Beaglehole, Stephen Jarman, Chris Frampton

{"title":"Dispensing of attention-deficit hyperactivity disorder medications for adults in Aotearoa New Zealand.","authors":"Ben Beaglehole, Stephen Jarman, Chris Frampton","doi":"10.26635/6965.6392","DOIUrl":"10.26635/6965.6392","url":null,"abstract":"Aim: To report dispensing trends for attention-deficit hyperactivity disorder (ADHD) in Aotearoa New Zealand, focussing on adults in order to highlight increasing demand for ADHD treatment by adults and to prompt discussion.Method: Demographic and dispensing data for ADHD were obtained from the Pharmaceutical Collection between the years 2006 and 2022. This was stratified according to child (<18 years) and adult (≥18 years) populations. Population dispensing rates for methylphenidate and atomoxetine were calculated. Key findings are reported to reveal demographic and dispensing trends for medication treated ADHD in Aotearoa New Zealand.Results: More males are dispensed ADHD medication than females, although this is less evident for adults (54.8% male). Māori adults are dispensed ADHD medication at a lower rate (10.1%) than Māori children (22.9%). There was a 10-fold increase in dispensing of ADHD medication for adults compared to a three-fold increase for children over the study period. New dispensing for adults doubled between 2011 and 2022.Conclusion: Medication treatment for adult ADHD is increasing in Aotearoa New Zealand and includes treatment for persisting childhood ADHD and new diagnoses made in adulthood. Despite increases, dispensing rates for ADHD remain lower than prevalence estimates, suggesting a significant treatment gap. Addressing the treatment gap for ADHD may reduce negative effects of ADHD, but wider social influences should also be considered.","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140870208","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

Preimplantation diagnosis and embryo selection in a patient with severe hereditary coproporphyria. 一名严重遗传性共卟啉症患者的胚胎植入前诊断和胚胎选择。

IF 1.7

NEW ZEALAND MEDICAL JOURNAL Pub Date : 2024-05-03 DOI: 10.26635/6965.6403

Gisela A Kristono, Leigh Searle, Cindy Towns

引用次数: 0

Health impacts of war: case studies of New Zealand veterans of the First World War. 战争对健康的影响：第一次世界大战新西兰退伍军人案例研究。

IF 1.7

NEW ZEALAND MEDICAL JOURNAL Pub Date : 2024-05-03 DOI: 10.26635/6965.6514

Nick Wilson, Jennifer A Summers, Christine Clement, George Thomson

{"title":"Health impacts of war: case studies of New Zealand veterans of the First World War.","authors":"Nick Wilson, Jennifer A Summers, Christine Clement, George Thomson","doi":"10.26635/6965.6514","DOIUrl":"https://doi.org/10.26635/6965.6514","url":null,"abstract":"Aim: Armed conflict remains a tragic feature of the modern world and so it is necessary to continue to study its health impacts. Even the study of historical conflicts is relevant given that certain health impacts are common to most wars e.g., post-traumatic stress disorder (PTSD).Methods: This study built on a previous quantitative analysis of a randomly selected group of 200 New Zealand veterans from the First World War (WWI). From this sample we selected 10 cases that illustrated particular themes around morbidity impacts.Results: The theme of severity of impacts was illustrated with a case who was severely wounded and died from suicide when back in New Zealand, and another case with severe PTSD. The theme of the high frequency of non-fatal conditions was revealed with cases illustrating new diagnoses (a case with n=8 diagnoses), hospitalisations for new conditions (n=6), non-fatal injury events (n=3) and for sexually transmitted infections (n=3). The theme of chronic debility as a consequence of various conditions was illustrated with cases who had suffered from being gassed or having gastroenteritis, malaria or pandemic influenza.Conclusion: These 10 selected cases reiterate how severe and extensive the morbidity burden for military personnel in WWI could be. Also illustrated is how the morbidity could contribute to adverse impacts on some of their lives after returning to New Zealand.","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866304","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

Anatomy of a health crisis. 剖析健康危机。

IF 1.2

NEW ZEALAND MEDICAL JOURNAL Pub Date : 2024-05-03 DOI: 10.26635/6965.6578

Lyndon Keene, Harriet Wild, Virginia Mills

引用次数: 0

Chronic traumatic encephalopathy-the first neuropathological report in New Zealand. 慢性创伤性脑病--新西兰首例神经病理学报告。

IF 1.7

NEW ZEALAND MEDICAL JOURNAL Pub Date : 2024-05-03 DOI: 10.26635/6965.6421

Fen-Lan Cherry Chang, Richard Lm Faull, Maurice A Curtis, Andrew M Chancellor, Michael E Buckland, Clinton P Turner

引用次数: 0

Navigating challenges: insights into chronic kidney disease care in South Auckland. 迎接挑战：对南奥克兰慢性肾病护理的见解。

IF 1.2

NEW ZEALAND MEDICAL JOURNAL Pub Date : 2024-05-03 DOI: 10.26635/6965.6543

Kalpa Jayanatha, Viliami Tutone, David Voss, Jamie Kendrick-Jones, Fakaola Otuafi, Fortune Ngwenya, Nogi Eiao, Rachel Spence, Andrew Hill

引用次数: 0

Management of chronic kidney disease for Māori in Aotearoa New Zealand: a summary of clinical practice guidelines. 新西兰奥特亚罗瓦毛利人的慢性肾病管理：临床实践指南摘要。

IF 1.2

NEW ZEALAND MEDICAL JOURNAL Pub Date : 2024-05-03 DOI: 10.26635/6965.6483

Curtis Walker, Susan Reid, Carla White, Merryn Jones, Lee-Ora Lusis, Rachael C Walker, John Collins, Helen Rodenburg, David Tunnicliffe, Suetonia C Green

{"title":"Management of chronic kidney disease for Māori in Aotearoa New Zealand: a summary of clinical practice guidelines.","authors":"Curtis Walker, Susan Reid, Carla White, Merryn Jones, Lee-Ora Lusis, Rachael C Walker, John Collins, Helen Rodenburg, David Tunnicliffe, Suetonia C Green","doi":"10.26635/6965.6483","DOIUrl":"10.26635/6965.6483","url":null,"abstract":"Aims: The kaupapa of the Caring for Australians and New Zealanders with Kidney Impairment (CARI) Clinical practice guidelines for management of chronic kidney disease for Māori in Aotearoa New Zealand is to provide whānau-centred and evidence-based recommendations to healthcare systems, healthcare providers and healthcare workers. The guidelines include screening, identification, management and system-level responses to chronic kidney disease (CKD) to deliver best practice care to Māori affected by CKD across community, primary and secondary services.Methods: The guidelines are funded by the Ministry of Health - Manatū Hauora and are written by a panel of Māori and non-Māori clinicians and literacy experts across Aotearoa New Zealand from Kaupapa Māori organisations, general practice and nephrology units using standardised methods. The guidelines methodology included consultation with whānau Māori with lived experience of CKD and primary and secondary care practitioners. Additional guideline development would be required to inform management of CKD for non-Māori in Aotearoa New Zealand.Results: The guidelines provide recommendations about equity, governance and accountability, cultural safety, case management, information systems, social determinants of equity and wellbeing and screening.Conclusions: Recommendations to health services for Māori with CKD are based on giving effect to Te Tiriti o Waitangi and best practice care to prevent CKD, delaying its progression, treating kidney failure through timely transplantation, delivering in community and providing high-quality symptom management.","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140865409","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