NEW ZEALAND MEDICAL JOURNAL最新文献

Patient trust is key to the delivery of healthcare and realisation of artificial intelligence's (AI) benefits in health. Trust in health institutions and the health professionals working within them directly impacts patient engagement with health services and their health outcomes. Patients want to be able to trust the health system and health services to respect, protect and use their data responsibly to minimise any potential harms. Further, when integrating AI within health services, patients want to be able to trust that this is done with good governance, including the correct approvals and processes, to ensure equitable and safe care. Due to the complexity and fast-changing landscape of AI and the varied levels of AI literacy, trust is arguably even more important. Patients need to be able to trust services to use their health information responsibly and integrate AI in care appropriately regardless of whether they fully understand the technology. Through transparency and good AI governance, trust can be built and maintained, but if broken or lost, it will be difficult to repair and will have wider implications. This paper provides recommendations for actions to be taken to build and maintain trust in health institutions within the context of the evolving AI landscape.

Recently the Health Research Council of New Zealand (HRC) announced the prioritisation of projects that enhanced the development of clinician-researchers. In this viewpoint article, we argue that a clinician-researcher career involving publicly funded, investigator-led clinical research with meaningful end points to inform clinical care is currently not sustainable in New Zealand.

Background: Burnout is a chronic syndrome that compromises physician wellbeing and patient care. This study aimed to quantify burnout among New Zealand ophthalmologists and identify key demographic and practice-related factors associated with increased risk, as well as to assess lifetime burnout experiences, time off taken and barriers to seeking help.

Methods: A cross-sectional study of 171 New Zealand ophthalmologists used a modified Mini Z 2.0 Burnout Survey to assess workplace satisfaction, stress and burnout, while additional questions gathered demographic and practice characteristics, as well as retrospective data on burnout frequency, time off taken, help sought and perceived barriers.

Results: Out of 161 delivered surveys, 84 responses were received (52% response rate). Overall burnout was 20%, with a significantly higher rate in the public sector (p<0.05). Burnt-out respondents reported notably lower job satisfaction, team effectiveness and workload control. No significant associations were found with other demographic or practice factors. Sixty-three percent had experienced burnout at least once, and 40% reported multiple episodes, yet only 15.5% took time off. Among those who sought help (51%), family members were the most common source of support, while 43% did not seek help, primarily due to time constraints.

Conclusion: This study shows that burnout affects one in five New Zealand ophthalmologists. Findings underscore the importance of reducing stigma and cultivating supportive environments that encourage help-seeking without fear of repercussions. Reducing administrative tasks and expanding mental health resources, especially in the public sector, may mitigate burnout and strengthen workforce recruitment and retention.

Aim: This study aims to investigate the relationship between experiences of discrimination (ethnic/race-based, gender and sexuality-based discrimination) in a healthcare setting, and healthcare services avoidance in Pacific Rainbow+ in Aotearoa New Zealand.

Methods: This study draws from a sample of Pacific Rainbow+ (Pacific cisgender sexuality minorities [n=239] and Pacific transgender and non-binary [n=126]) individuals taken from the Manalagi Survey. Multivariate logistic regression analyses were performed to test for a relationship between predictors based on respondent self-reported experiences, within a healthcare setting in Aotearoa New Zealand, of discrimination (race/ethnic discrimination or racism, sexuality and/or gender diversity-homophobia/transphobia and heterosexism) and outcome variables (avoiding healthcare and mental health services).

Results: Discrimination based on ethnicity/race was more highly reported by both cisgender sexuality minorities and the transgender and non-binary groups in our sample, with this typology of discrimination also associated with increased odds of healthcare services avoidance. Discrimination based on race/ethnicity was further associated with increased likelihood of mental health service usage. On average, cisgender sexuality-diverse respondents reported 1.15 instances of listed forms of discrimination, and this nearly doubled for transgender and non-binary respondents. Notably, when the overall number of discriminatory exposures increased by a single point, respondents had an approximate 60% odds ratio (OR) of healthcare avoidance.

Conclusion: This study affirms findings of much research that describe discrimination (multiple forms) as a common experience for Rainbow+ individuals while seeking out healthcare services. Further, it reveals that these experiences have a predictive impact on the likelihood of Pacific Rainbow+ avoiding healthcare services. While this study's cross-sectional nature limits the ability to infer causality, these findings do underscore the importance of undertaking more intersectional research into the drivers and inhibitors of healthcare-seeking behaviours and healthcare service usage of Pacific Rainbow+ in Aotearoa New Zealand.

Aims: Emerging research suggests exposure to vape stores and their proximity to schools play a role in vaping initiation among adolescents. In New Zealand, regulatory changes enacted that restrict sales of flavoured vape products to specialist vape retailers (SVRs) have led to growth in "store-within-a-store" (SWAS) SVRs in or beside convenience stores to circumvent restrictions. This paper assesses the number and type of SVR retailers, including SWAS, and their proximity to educational institutes (primary, secondary and tertiary) and marae across Auckland suburbs with different socio-economic deprivation levels.

Methods: Google Maps data and tools were used to assess SVR "type" and distance from schools, marae and other SVRs in selected Auckland suburbs. One hundred and sixty SVRs were examined across 14 suburbs.

Results: The median number of SVRs per suburb was 9.5. Forty-four percent of SVRs were SWAS. SWAS density increased with socio-economic deprivation, with high-deprivation suburbs containing a median of 8.5 SWAS compared with 2.0 in low-deprivation suburbs. Half of the SVRs (56%) were located within 300m of at least one educational institute.

Conclusion: SWAS density in Auckland increased with neighbourhood socio-economic deprivation. SWAS retailers likely contribute to greater exposure to vape retail and products among adolescents in these areas.

Aims: Income is a key determinant of health and health equity. This paper outlines the current welfare supports for people with longterm conditions and reviews the issues associated with accessing those supports, particularly during health system engagement.

Methods: Weaving a Kaupapa Māori methodology, the He Pikinga Waiora framework and a qualitative approach, our team spoke to 130 healthcare providers across the Waikato Region in face-to-face and virtual engagements about system-level issues associated with accessing welfare support. Notes taken during these engagements were analysed using inductive thematic analysis, systems thinking and a Kaupapa Māori lens.

Results: Because of the way health and welfare systems operate and limited access to advocacy, computerised resources and information about welfare and other supports, key informants observed that patients experienced many difficulties accessing the right type and level of welfare support, with likely consequent impact on health outcomes. These realities were exacerbated because providers were not enabled to help patients navigate the welfare system.

Conclusion: The health and welfare systems are not designed to enable access to welfare support. Providers could have a more meaningful role ensuring equitable access to welfare and other supports but are underfunded, understaffed and unsupported. A more integrated approach and cross-sectoral action are needed.

Aim: This study examines whether ethnicity is an independent marker of health or if ethnic disparities are fully explained by age, sex, rurality, socio-economic position and morbidity.

Method: Using the Stats NZ Tatauranga Aotearoa Integrated Data Infrastructure, we identified the resident population of Aotearoa New Zealand each year from 2009 to 2018, establishing 10 cohorts that were followed up with at 12 months for amenable mortality, i.e., deaths from conditions responsive to healthcare in under-75-year-olds. Age, sex, ethnicity, rurality, small area deprivation, personal income and morbidity of cohort members were described. Logistic regression analyses and likelihood ratio tests were used to assess the independent association of these variables with amenable mortality.

Results: Ethnicity, socio-economic position and morbidity, along with age, sex and rurality, made significant independent contributions to predicting amenable mortality. Ethnicity predicted amenable mortality after adjusting for other variables. Compared with Europeans, the odds of amenable mortality were 1.46 (95% confidence interval [CI] 1.43-1.50) times greater in Māori and 1.18 (95% CI 1.14-1.23) times greater in Pacific and half as likely in Asian (0.54, 95% CI 0.52-0.57).

Conclusion: Māori and Pacific ethnicity, and also socio-economic position and morbidity, are independent markers of health need relevant to the distribution of health resources and targeting of health services.

Aim: Anastomotic leak (AL) is associated with major post-operative morbidity and mortality. The circular stapler, widely utilised in colorectal anastomosis, has seen a technological change from manual firing stapler (MFS) to powered automated firing stapler (PAFS). PAFS may reduce user error and technique variation and may be associated with reduced AL rate. The primary aim of the study was to assess differences in AL rate between MFS and PAFS. Secondary aims were to assess differences in length of stay (LOS) and 30-day mortality.

Methods: This was a retrospective, single surgeon review of patients undergoing resection with anastomosis using a circular stapler between 2016 and 2023. A historical MFS group (n=105) and a study PAFS group (n=112) were identified. Demographics, comorbidity, operation type, neoadjuvant therapy, AL, LOS and 30-day mortality were recorded.

Results: The populations were comparable, with no significant difference in demographics, BMI, ASA grade, neoadjuvant radiotherapy use or type of operation. The PAFS group contained more non-malignant cases, 35% vs 18% (p=0.01). AL rate was 11.4% in the MFS group and 3.6% in the PAFS group (p=0.04). Fifty-eight percent of the anastomotic leaks in the MFS group needed surgery, compared to zero from the PAFS group (p=0.09). Mean LOS was 10 days in the MFS group and 6 days in the PAFS group (p = 0.01). Thirty-day mortality was 0.9% from the MFS group and zero from the PAFS group (p=0.48).

Conclusion: While acknowledging confounders may have affected outcomes, in this study PAFS was safe and associated with a significant reduction in AL and LOS.