NEW ZEALAND MEDICAL JOURNAL最新文献

Pseudoaneurysms of the brachial artery have been reported in the literature, with aetiologies including iatrogenic causes, trauma and intravenous drug use. Among traumatic causes, blunt trauma is the most common, and the incidence of brachial artery pseudoaneurysms due to penetrating injuries is approximately 0.04%. The presentations are usually late, mainly after months or years, but the presentation within a week is rare. The management includes computed tomography (CT) angiography as the modality for diagnosis and endovascular or surgical approaches-the surgery is either graft or end-to-end repair. However, well-defined protocol-based management, as well as the keen suspicion of such a rare entity, is necessary for trauma or vascular surgeons to prevent further morbidities or mortality.

Aim: With the phase one Royal Commission COVID-19 report published, it is an opportune time to reflect on the various public health interventions used to consider if they were effective and how they could be improved. As we look to the future, it is important to understand if digital contact tracing (DCT) was an effective public health intervention during the COVID-19 pandemic and how it could be improved.

Method: We summarise a series of articles detailing the population and public uptake of the various DCT technologies implemented in Aotearoa New Zealand during the COVID-19 pandemic.

Results: New Zealand had one of the highest population uptakes of DCT in the developed world. However, there were additional barriers to the full implementation of these tools that likely reduced their efficacy.

Conclusion: DCT was just one of many interventions aiming to eliminate, and then suppress, COVID-19. This context makes it difficult to isolate and conclude that the efficacy of DCT during this pandemic would translate to future pandemic conditions, especially if there is improved design and implementation. However, this research shows that the self-service survey approach worked better than expected, and that there is some promise in automating notification processes.

Introduction: Human civilisation faces global catastrophic risks such as: nuclear war, bioengineered pandemics, major solar storms and a volcanic winter. For some of these catastrophes, island nations may have relative survival potential but any collapse in international trade could also end critical imported goods such as pharmaceuticals. We aimed to explore the latter in New Zealand, a highly trade-dependent island nation.

Methods: We identified the 10 most extensively prescribed pharmaceuticals in New Zealand that can be used for acute treatment (by annual prescription numbers). Based on modern synthesis pathways for these pharmaceuticals in the literature, we identified ingredients and then determined if these ingredients were currently produced in New Zealand.

Results: The results suggest that none of these 10 pharmaceuticals could be produced in New Zealand in a trade-ending catastrophe: paracetamol, omeprazole, amoxicillin, ibuprofen, aspirin, metoprolol succinate, salbutamol, prednisone, cetirizine hydrochloride and amlodipine. This is primarily because New Zealand does not refine petrochemicals. For seven of these 10 pharmaceuticals the relevant catalysts or other specific chemical ingredients are also not mined or otherwise produced in New Zealand. There may, however, be some scope for the post-catastrophe scavenging of minerals for producing some catalysts.

Conclusions: This preliminary analysis suggests that none of the 10 most extensively prescribed pharmaceuticals that can be used for acute treatments could be manufactured in New Zealand after a trade-ending global catastrophe. To address this and other domains lacking in resiliency (e.g., liquid fuel supply), planning for building shared resiliency with other neighbouring nations (e.g., Australia) could be considered.

Aim: Previous research suggested that Māori patients have a lower incidence of pulmonary embolism (PE) compared to Europeans.5-7 The aim of this study was to re-examine this in the Bay of Plenty (BOP) region of Aotearoa New Zealand.

Method: This retrospective study analysed all computed tomography pulmonary angiography (CTPA) scans completed from 1 February 2024 to 31 July 2024. Age-standardised rates for CTPA and PE in Māori were calculated using indirect standardisation to the European population.

Results: Of the scans completed, 719 CTPA scans met inclusion criteria. When age standardised, Māori received more CTPAs than Europeans, with an incidence ratio of 1.50 (95% CI [confidence interval] 1.34 to 1.68, p <0.0001). The age-standardised incidence of PE for Māori was 82.0 (95% CI 69.6 to 108) per 100,000 person years, and for Europeans was 87.0 (95% CI 65.1 to 102) per 100,000 person years, with an incidence ratio of 1.06 (95% CI 0.77 to 1.46, p=0.70).

Conclusion: This study demonstrates no ethnic difference in the age-adjusted incidence of PE. These findings suggest that ethnicity should not be used in isolation for clinical decision making. Higher rates of CTPA in Māori suggest an equitable approach to CTPA scan requesting.

Colonoscopy is a cornerstone of colorectal cancer screening with a low incidence of complications such as bleeding and perforation. Infectious complications such as liver abscesses are exceedingly rare. We report a case of a 72-year-old Sri Lankan man with a background of diabetes mellitus and diverticulosis who developed a pyogenic liver abscess (PLA) following an uncomplicated colonoscopy performed as part of the New Zealand bowel screening programme. The abscess was caused by Klebsiella pneumoniae, a pathogen commonly associated with such infections. He was successfully treated with broad-spectrum antibiotics and ultrasound-guided drainage. This case raises the possibility of a rare association between colonoscopies and pyogenic liver abscesses, even in non-invasive procedures, particularly in high-risk patients, though direct causality cannot be established. We reviewed potential mechanisms and relevant literature in this case report.

Background: Meaningful community engagement is essential when designing health services and initiatives. Te Wāhi Tiaki Tātou was established as the Porirua locality under the Pae Ora Act 2022 to support place-based approaches to hauora. Our community engagement takes the form of "reimagining sessions":, facilitated hui that elevate lived experience as a powerful and essential form of evidence in health service design.

Methods: Reimagining sessions blend principles from participatory action research (PAR) and service design, grounded in Te Tiriti o Waitangi. From PAR, they draw on honouring lived experience as expertise. Service design contributes sequencing and holistic thinking principles. Shared principles across both PAR and service design are community-centred approaches, where whānau are positioned as co-creators (from service design) or co-researchers (from PAR), and power sharing with the community to create space for true community-led decision making. Whānau and providers are invited separately to map their experiences of current health services and envision an ideal future state. Sessions are guided by relational engagement and reflexive practice.

Results: Reimagining sessions are more than a consultation mechanism, and serve to share power and elevate community voice. Outputs are synthesised into action-oriented reports validated by participants. Our learnings highlight the importance of trusted relationships, culturally safe environments and emotional anchoring to support aspirational thinking.

Conclusion: Reimagining sessions demonstrate that whānau-led change is possible when communities are treated as experts in their own lives. They reflect a shift from consultation to collaboration, from systems-centred to whānau-centred and from generic services to community-informed services.