NEW ZEALAND MEDICAL JOURNAL最新文献

Aim: 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.

Method: 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.

Results: 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.

Conclusion: 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.

Aim: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

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.

Aim: 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.

Method: 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.

Results: 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.

Conclusion: 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.

Aim: New Zealand's Ministry of Health sets three quality metrics for inpatient stroke care: admission to an organised stroke unit within 24 hours (target 80%), appropriate use of reperfusion therapy (target 12% for ischemic stroke) and transfer to rehabilitation services within 7 days (target 80%). Our aim was to evaluate a large Auckland tertiary hospital's performance against these indicators.

Methods: A retrospective study of 200 consecutive stroke patients admitted between April 4 and August 1, 2021, was conducted.

Results: Fifty percent (100/200) of patients were admitted to the stroke unit within 24 hours. Sixteen point six percent (27/183) of ischaemic stroke patients received reperfusion therapy. Twenty-four point five percent (49/200) were transferred to rehabilitation services, of which 40.8% (20/49) were within 7 days of presentation. Patients were less likely to be admitted to the stroke unit within 24 hours if not admitted by the stroke service, if admitted out-of-hours or if suffering an inpatient stroke. Timely admission to the stroke unit was associated with receipt of reperfusion therapy, shorter time to inpatient rehabilitation transfer and shorter duration of admission. Patients with inpatient stroke were less likely to be discharged in a timely manner (adjusted hazard ratio [HR] 0.19; 95% CI 0.07-0.50). All-cause mortality during a hospitalisation episode with a stroke diagnosis was likely to occur early in the admission (adjusted HR 1.82; 95% CI 1.01-3.32).

Conclusions: The hospital met the reperfusion therapy target but fell short on timely stroke unit admission and rehabilitation transfer. An after-hours effect on stroke unit admission was observed, previously undocumented in New Zealand.

Aim: To evaluate the available data on mental health and substance-related harm among infants, children and young people (ICY) in Aotearoa New Zealand.

Methods: A scoping review was undertaken to take stock of current data and identify gaps.

Results: Although there are quality studies, there is a lack of comprehensive, contemporary population-based data to monitor the prevalence and magnitude of mental health conditions and substance use-related harm for children and young people. Existing data are inconsistently measured and are not centrally located or available for all age groups, particularly infants and children. Whānau/family units are seldom considered or prioritised.

Conclusions: Aotearoa New Zealand lacks accurate, up-to-date, comprehensive ICY mental health and substance use data to inform investment, service delivery and evidence-based policy. We advocate for enhanced surveillance and monitoring through population-based mental health and addiction studies with Indigenous and other locally designed measures, and propose key design and ethical considerations for future research. Future research must prioritise Māori and other priority groups, with non-stigmatising, strengths-based approaches. Addressing these data gaps presents a critical opportunity to improve outcomes for children, young people and their whānau.

Aim: This study aims to document the age verification processes for online alcohol deliveries in Auckland, New Zealand, with a focus on rapid alcohol delivery (delivery within 2 hours of ordering).

Methods: Alcohol orders from Auckland online alcohol delivery companies were placed by a researcher under 25 years of age over a 2-month period in 2023. Procedures were recorded around speed of delivery and age verification processes.

Results: In total, 33 (73%) of the 45 online alcohol orders did not require age verification at delivery. This comprises 22 (49% of the total) deliveries left unattended at the door and 11 (24%) in-person deliveries that did not request age verification. The average speed of delivery for rapid alcohol delivery companies was 29.5 minutes and the standard deviation 9.5 minutes.

Conclusion: It is common for online alcohol deliveries in Auckland to be left unattended on delivery or delivered without requesting identification. This has implications for increasing alcohol-related harm, including supply to minors. Additional regulation addressing alcohol delivery is needed in New Zealand.