NEW ZEALAND MEDICAL JOURNAL最新文献

{"title":"Assessing the impact of physical, mental and cognitive impairments on health-related quality of life in sepsis survivors following intensive care admission in New Zealand.","authors":"Patrice Rosengrave, Jonathan Williman, Geoff Shaw, Anitra C Carr","doi":"10.26635/6965.6638","DOIUrl":"10.26635/6965.6638","url":null,"abstract":"<p><strong>Aim: </strong>To assess the impact of physical, mental and cognitive impairments on health-related quality-of-life (QoL) of individuals who have survived sepsis after admission to an Intensive Care Unit (ICU) in New Zealand.</p><p><strong>Methods: </strong>Survivors from a trial investigating vitamin C as an adjunctive therapy in patients with sepsis in Christchurch Hospital ICU were invited to enrol in a longitudinal QoL follow-up study. Patients were interviewed at hospital discharge, 30, 90 and 180 days, using validated physical and mental health assessment questionnaires (Short-Form-36, EuroQol-5-Dimension). Cognitive function was monitored and results compared with New Zealand population norms.</p><p><strong>Results: </strong>Eighteen of the 26 survivors participated in the 6-month QoL follow-up. At hospital discharge, there were significant physical and mental health issues in the participants interviewed, and although a majority of the subscales improved over the 6-month follow-up, physical function, role-physical and general health were still below population norms. Following discharge, objective parameters (mobility, self-care, usual activities) normalised within 3-6 months, while subjective measures (pain/discomfort and anxiety/depression) improved earlier and were better than population norms at 3-6 months. Cognitive dysfunction persisted over the follow-up period. Short-term (4-day) vitamin C intervention in the ICU did not affect health parameters post hospital discharge.</p><p><strong>Conclusions: </strong>Survivors of septic shock experience elevated physical, mental and cognitive issues at discharge. Most mental health issues had resolved by 6 months, but some physical and cognitive issues had not returned to population norms. Short-term vitamin C administration did not improve long-term health-related QoL; however, ongoing vitamin C supplementation may be required.</p>","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"137 1607","pages":"22-33"},"PeriodicalIF":1.2,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819832","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":"Ethnic variations in traumatic injury hospitalisations in a health region of Aotearoa New Zealand-10-year review.","authors":"Ishani Soysa, Sheena Moosa, Grant Christey","doi":"10.26635/6965.6659","DOIUrl":"10.26635/6965.6659","url":null,"abstract":"<p><strong>Aim: </strong>To examine the ethnic variations in trauma hospitalisations in a health region of Aotearoa New Zealand over a 10-year period.</p><p><strong>Methods: </strong>A retrospective, observational study utilised data from the Te Manawa Taki (TMT) regional trauma registry to identify individuals of all ages and injury severities who were hospitalised due to injuries between 2013 and 2022. This investigation focusses on the epidemiology of trauma, examining factors such as ethnicity, gender, Injury Severity Score (ISS) and injury characteristics.</p><p><strong>Results: </strong>In the TMT region, out of the 60,753 trauma patients admitted to hospitals, the distribution across ethnic groups was as follows: 39,291 (64.7%) were European and other ethnic group, 18,015 (29.7%) were Māori, 1,998 (3.3%) were Asian and 1,411 (2.3%) were Pacific peoples. Notably, there were significant differences in incidence rates among these groups, with Māori exhibiting the highest rate. Moreover, males were more predisposed to hospitalisation due to trauma compared to females. This gender discrepancy was consistent across all ethnicities. Regardless of ethnicity, falls and road traffic crashes emerged as leading causes of trauma across all severity levels. Additionally, the primary location of injury varied depending on the severity of trauma. For high-severity cases, street and highways were the predominant sites, whereas homes were more commonly associated with low-severity admissions.</p><p><strong>Conclusions: </strong>The study examines the incidence, demographic characteristics, severity and outcomes of trauma patients across various ethnic backgrounds admitted to hospitals within the TMT region of Aotearoa New Zealand over a decade. The disparities in injury rates among different ethnic groups underscore the substantial strain on the healthcare system. Pinpointing high-risk demographics and recognising these disparities will be instrumental in devising targeted prevention measures, enhancing access to culturally sensitive trauma services and advancing health equity.</p>","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"137 1607","pages":"75-86"},"PeriodicalIF":1.2,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819838","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":"Case study of a potential West Polynesian variant of von Hippel-Lindau disease.","authors":"Eugene Michael, Peter Hadden, Stephen Robertson","doi":"10.26635/6965.6493","DOIUrl":"https://doi.org/10.26635/6965.6493","url":null,"abstract":"","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"137 1607","pages":"98-101"},"PeriodicalIF":1.2,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819834","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 first trimester abortion journey Aotearoa: health practitioners' perspectives.","authors":"Emma Macfarlane, Pauline Dawson, Michael Stitely, Helen Paterson","doi":"10.26635/6965.6647","DOIUrl":"https://doi.org/10.26635/6965.6647","url":null,"abstract":"<p><strong>Aim: </strong>To gain insight into health practitioners' understanding of how people experience the first trimester abortion journey.</p><p><strong>Methods: </strong>Qualitative interviews informed by phenomenology with health practitioners from a range of practice settings across Aotearoa New Zealand. Participants were recruited via a separate but related study. Inductive thematic analysis was used to develop themes.</p><p><strong>Results: </strong>Interviews were undertaken with 18 health practitioners. Analysis revealed three main themes: 1) abortion is a stepwise process, 2) barriers to accessing abortion care, and 3) solutions to improve access to abortion care. There were a number of sub-themes.</p><p><strong>Conclusion: </strong>While there remain multiple personal, institutional and societal barriers to abortion in Aotearoa, this study identifies potential solutions and that a desire for positive change among health practitioners exists. To achieve this, a strategy is required to ensure that the health consumer is placed at the centre of abortion services to provide accessible, equitable and culturally appropriate care. The primary care sector stands to play a significant role in future abortion provision but requires appropriate funding and support to do so.</p>","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"137 1607","pages":"67-74"},"PeriodicalIF":1.2,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819847","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":"Outcomes following the introduction of an interdisciplinary shared decision-making clinic for older patients with colorectal cancer.","authors":"Alison Jackson, Christopher Shaw, Brian O'Sullivan, Siva Govender, Jesse Fischer","doi":"10.26635/6965.6476","DOIUrl":"10.26635/6965.6476","url":null,"abstract":"<p><strong>Aim: </strong>Colorectal cancer (CRC) incidence is highest in older patients, who also have high rates of concurrent multimorbidity and frailty. Shared decision making is important when deciding treatment. The aim of this study was to compare outcomes before and after introduction of a shared decision-making (SDM) pathway, which includes an anaesthetist and geriatrician, for older patients with CRC at Waikato Hospital.</p><p><strong>Method: </strong>Retrospective review of patients over 70 years of age considered for surgical resection was performed before (2018) and after (2020) introduction of the SDM pathway. Primary outcome was days alive out of hospital (DAOH) at 12 months. Data were collected on demographics, disease factors, specialist assessments, frailty and cognitive function, treatment, deviation from colorectal multi-disciplinary meeting (MDM) recommendation and outcomes.</p><p><strong>Results: </strong>In total, 169 patients were included. There were 103 males and the median age was 79 years (range 70-95). After the introduction of the SDM clinic, more patients underwent non-operative management (16.1% vs 4.9%, p=0.02) and had management that deviated from MDM recommendation (18.4% vs 4.9%, p=0.01). DAOH was marginally higher after introduction of the SDM clinic (358 vs 352, p=0.02). There was no difference in survival.</p><p><strong>Conclusion: </strong>An interdisciplinary SDM clinic for older patients with CRC is feasible in a tertiary hospital in New Zealand and may increase non-operative management and DAOH without impacting overall survival.</p>","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"137 1606","pages":"40-48"},"PeriodicalIF":1.2,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752033","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":"A rare presentation of ST-elevation, mimicking an acute coronary syndrome, as a manifestation of seizure disorder-a case report.","authors":"Maxine Cooper, Michael Dick, Pradeep Sreekumar","doi":"10.26635/6965.6695","DOIUrl":"https://doi.org/10.26635/6965.6695","url":null,"abstract":"","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"137 1606","pages":"101-104"},"PeriodicalIF":1.2,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752015","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":"Key factors related to happiness and anxiety in Aotearoa New Zealand during the COVID-19 pandemic.","authors":"Mana Mitchell, Bradley I Tomlinson, Grace O Egan, Yanming Huang, Emily C Kellett, George P F Rowley, Sophie I Tang, Ysobel G Maindonald, Ellie M Logan, Bruce R Russell, Nicholas Bowden, Olivia K Harrison","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>Mental wellbeing has been one of the most prominent health concerns in Aotearoa New Zealand and has only been exacerbated by the COVID-19 pandemic. Here we explored factors associated with anxiety and happiness in a mid-pandemic climate in Aotearoa.</p><p><strong>Methods: </strong>Analyses were performed on the anxiety and happiness scores from the wellbeing survey in December 2020 (Statistics NZ Tatauranga Aotearoa; 30,000 responders contacted for the Household Labour Force Survey). Correlations and general linear models were used to identify significant predictor variables related to anxiety and happiness scores.</p><p><strong>Results: </strong>A number of factors correlated with both anxiety and happiness, including loneliness, physical health, family wellbeing, financial wellbeing, age and gender. After controlling for many ethnically stratified social burdens, Māori and Pacific populations demonstrated higher levels of happiness. Discrimination was only associated with anxiety, while generalised trust, trust in the police and in the health system all related to happiness.</p><p><strong>Conclusion: </strong>Anxiety and happiness in a mid-pandemic environment shared many related variables spanning physical, social and financial domains. Additionally, anxiety was associated with greater levels of discrimination, and happiness with trust in public services. Here we provide a window into the state of mental wellbeing in Aotearoa during a global health crisis.</p>","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"137 1606","pages":"73-91"},"PeriodicalIF":1.2,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752031","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 need for diagnosis in dementia.","authors":"John Turbott","doi":"10.26635/6965.6786","DOIUrl":"https://doi.org/10.26635/6965.6786","url":null,"abstract":"","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"137 1606","pages":"105-106"},"PeriodicalIF":1.2,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752036","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":"Cultural safety support and requirements for international medical graduates in Aotearoa New Zealand.","authors":"Analee Toro, Gabrielle McDonald, Peter Crampton","doi":"10.26635/6965.6525","DOIUrl":"10.26635/6965.6525","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the requirements for, and process of, cultural safety training for international medical graduates (IMGs) when seeking to gain registration in Aotearoa New Zealand.</p><p><strong>Method: </strong>To identify cultural safety standards and policies for IMGs: 1) a review of training policies of seven specialist colleges and other key organisations was carried out, and 2) four key informant interviews were conducted, and interviews were recorded and transcribed via Zoom. Thematic analysis was used to analyse the transcripts.</p><p><strong>Results: </strong>There are no mandatory requirements for IMGs to be trained in or to demonstrate cultural safety when applying for registration within the medical workforce of Aotearoa. There is limited support and training for IMGs in cultural safety. The themes identified from key informant interviews were: resource availability, cultural safety expectations for IMGs and education responsibilities.</p><p><strong>Conclusion: </strong>To support the provision of high-quality care to communities throughout Aotearoa, it is essential that cultural safety training for IMGs is both mandatory and readily available.</p>","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"137 1606","pages":"49-62"},"PeriodicalIF":1.2,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752017","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 impact of surgical time of day and surgical site infection.","authors":"David Cumin, James F Cheeseman, Guy R Warman","doi":"10.26635/6965.6701","DOIUrl":"10.26635/6965.6701","url":null,"abstract":"<p><p>Disruption to the circadian clock has impacts on health and wellbeing, including impaired immune function and wound healing. It is plausible that the timing of surgical procedures could impact the body's response to trauma and susceptibility to infections. Using the Health Quality & Safety Commission data on surgical site infections (SSI) we sought to investigate any possible time of day effects on the incidents of recorded infections. All recorded data from June 2017 to July 2021 were extracted for cardiac and orthopaedic operations in New Zealand. The incidence of SSI was calculated for each 4-hour bin of time across the day. There was a total of 87,034 cases in the analysis, of which 1,327 (1.5%) had an infection. Univariately, there was a significant time of day effect, with operations after 8 pm being 3.91 times more likely to have an infection (p<0.001), and operations between 4 pm and 8 pm being 0.71 times more likely (p=0.03) to have an infection compared to operations conducted between 12 pm and 4 pm. However, when age, acuity and American Society of Anesthesiologists score were included in the model, there were no differences in the rate of infection by time of day. This preliminary work suggests that surgical time of day does not significantly impact incidence of surgical infection when other variables are controlled for. However, this work has not considered other factors that may also be important. We plan to link the SSI data with the National Minimum Dataset to investigate these other factors and conduct a more comprehensive analysis.</p>","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"137 1606","pages":"107-109"},"PeriodicalIF":1.2,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752035","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}