NEW ZEALAND MEDICAL JOURNAL最新文献

Aim: The aims of this study are to describe the current status of the heart failure nursing workforce in Aotearoa New Zealand, identify key challenges and provide recommendations.

Method: In March 2023, a survey coordinated by the Cardiac Society of Australia and New Zealand and the New Zealand Regional Heart Failure Working Group was distributed to all district health boards in Aotearoa New Zealand. The survey collected data on heart failure nursing resources, including full-time equivalent (FTE) per population, clinical versus non-clinical time, scope of practice, nurse-led services, and performance measures.

Results: A total of 23 hospital responded, yielding a 100% response rate and revealing varied resource allocation across district health boards. While FTE rates have generally increased, nearly half of the boards reported less than one FTE per 100,000 population, with only three reaching the recommended two FTE per 100,000 as endorsed by the British Society for Heart Failure.

Conclusion: This foundational survey highlights the current status of the heart failure nursing workforce in Aotearoa New Zealand. It suggests that increasing the number of specialised nursing staff, particularly nurse practitioners (NP), to meet international standards would improve access to timely, effective and equitable treatment for all heart failure patients. Increasing NP FTE across hospital and community settings is likely to enhance healthcare and social outcomes, especially in under-served regions. Further research focussing on ethnicity, geographic distribution and workforce participation is recommended to guide targeted workforce development.

Aim: We aimed to describe the experience of strengthening leadership at a hospital to improve patient outcomes and staff satisfaction and wellbeing.

Method: Following a review of the Hutt Hospital Emergency Department, several actions were taken to strengthen the capacity, culture and leadership of the department. In addition, an organisation-wide values and culture exercise was undertaken. Senior clinical and non-clinical leaders were provided with interprofessional leadership training to foster shared understanding, strengthen relationships and promote practical application of learned skills.

Results: Subsequent external reviews of the emergency department documented a significant change in its culture and functioning; these changes have endured, and it is now a preferred place to train and work. Wider organisational leadership training was an essential part of creating a culture that valued staff and their wellbeing, and delivering better outcomes for patients. Involving local health system leaders, e.g., from primary care, provided significant additional value.

Conclusions: Healthcare organisations and the health system are complex and present a myriad of leadership challenges. Healthcare leaders need and deserve specific training and strong support to lead effectively. A focus on this is essential if New Zealand is to successfully address health system challenges, both old and emerging.

Aim: We aimed to quantitatively evaluate educational performance of Māori and Pacific Admission Scheme (MAPAS) interventions at Waipapa Taumata Rau | The University of Auckland (UoA) from 2016 to 2023.

Method: We measured the performance of student cohorts studying in MAPAS foundation and bachelor's degree programmes using standard Tertiary Education Commission (TEC) indicators. We compared MAPAS results with all Māori and Pacific student cohorts studying equivalent-level courses at UoA in the same period.

Results: Students supported by MAPAS interventions surpassed results for all UoA Māori and Pacific students across all indicators. From 2016 to 2023, MAPAS foundation course pass and graduation rates were 15-23 percentage points higher, and MAPAS bachelor's course pass rates, retention and graduation rates were 8-18 percentage points higher than equivalent UoA Māori and Pacific student averages. From 2020 to 2023, 232 MAPAS students graduated with a bachelor's degree-at least 62 more than could be expected with standard support pathways.

Conclusion: The success of MAPAS interventions warrants sustained and enhanced investment. To align with population demographics, universities in Aotearoa should aspire for a minimum of 30% Māori and 15% Pacific graduates in health professional programmes. Pro-equity health workforce initiatives such as MAPAS are essential for transformation towards a culturally safe health system.

Exposures in utero and in early life have the potential to influence health across the lifespan through neurological, epigenetic and other physiological processes. Very low birthweight (VLBW; <1,500g) and very preterm (VP; <32 weeks gestation) births constitute around 2% of live births but have significant child, family and public health impacts neonatally and longer term. Parents/caregivers, funders and society want to know the quality of that survival across the lifecourse. The New Zealand 1986 Very Low Birthweight Follow-up Study is a population-based, longitudinal study that has followed a national cohort of individuals from birth in 1986 across childhood and into adulthood. At a mean 28.5 years, 250 VLBW adults (77% survivors; 25% Māori) and 100 term-born controls participated in follow-up, with 229 VLBW adults and all controls attending a 2-day medical and neurocognitive assessment. The aim of this report is to give an overview of the published major findings from the 28-year assessments. The majority of VLBW young adults were living healthy productive lives, similar to their term-born peers. Biomedical measurements were mostly in the normal range, although between-group mean differences tended to favour the controls, suggesting potential risk of premature organ function decline within the VLBW group. We compare our results with other emerging international data and discuss the implications for future research and possible interventions across the lifecourse to optimise outcomes for this vulnerable group.

Antenatal depression affects 15-21% of pregnant women globally, increasing the risk of pregnancy complications, postnatal depression and poor birth and infant outcomes. Psychotherapy is a recommended treatment, but access barriers like cost, time and stigma often prevent their use. For severe cases, antidepressants are advised; however, only 3% of pregnant women in New Zealand take antidepressants, with concerns about risks to their infant identified as a main reason for discontinuing medications. Poor nutrition during pregnancy, particularly ultra-processed foods, is associated with higher maternal depression and greater likelihood of mental health issues in the offspring. Increasing consumption of real whole foods improves outcomes for both mother and infant. As proof that the nutritional environment during pregnancy is inadequate, a randomised placebo-controlled trial in pregnancy for women with moderate depression is showcased to illustrate the importance of supplementing with vitamins and minerals (micronutrients) in recovery from antenatal depression. The additional micronutrients also mitigated the negative effects of depression on birth outcomes and improved early indicators of infant competencies, with more favourable birth and infant outcomes compared to antidepressants. The substantially enhanced birth outcomes emphasise the potential for significant healthcare savings. The breadth of data urges updates to the current guidelines from the Royal Australia and New Zealand College of Psychiatrists and the Royal Australia and New Zealand College of Obstetricians and Gynaecologists to include nutrition intervention as part of maternal care.