NEW ZEALAND MEDICAL JOURNAL最新文献

Aim: The National Bowel Screening Programme (NBSP) fails to deliver screening equitably to Pacific New Zealanders. This research explored Tongan New Zealanders' experiences of participating in the NBSP and their views on ensuring the programme works well for the Tongan community.

Method: In 2021, we conducted two talanoa focus groups with Tongan New Zealanders who had participated in the NBSP (n=26), recruited through a Pacific provider in Auckland. Participants were aged 60 or more and were Tongan born. Interviews with four Pacific experts working in the NBSP were also undertaken. Their views on the NBSP were explored and analysed using thematic analysis.

Results: While the research participants valued the opportunity to participate in the NBSP, they had many valuable insights about strengthening it, as did the Pacific experts. Key was a by Tongan, for Tongan service run by Tongan providers, one based on Tongan models of health and health promotion, Tongan values and ways of working, and using the Tongan language, which empowers Tongans to take control of their health.

Conclusions: This research demonstrates critical elements of an effective, culturally appropriate and empowering NBSP for Tongans led by Tongan providers. If these findings are enacted, more effective delivery of bowel screening to Tongans will likely be enabled, reducing inequity in participation between Tongans and other New Zealanders. What is required is courage and political will to shift power and resources to ensure equitable outcomes in the NBSP, not only for Tongans but for all Pacific peoples.

Background: Malignant gastric outlet obstruction (GOO) poses a substantial symptomatic burden. While various therapeutic options exist, self-expanding metal stents (SEMS) are a common palliative choice for patients who are ineligible for surgery. We studied SEMS outcomes to identify factors influencing stent dysfunction and patient survival.

Methods: A multi-centre, retrospective review of 190 patients with GOO undergoing SEMS at three tertiary hospitals was performed over 2016-2022. Technical success, clinical success and adverse outcomes were recorded. Predictors of stent dysfunction and survival were evaluated using multivariate regression.

Results: Technical success was achieved in 186/190 (97.9%) and clinical success in 156/186 (83.9%), defined as post-procedural gastric outlet obstruction symptom score (GOOSS) ≥2. Eighty-two (44.1%) patients experienced an adverse event with stent occlusion the most common (23.1%). Approximately one-third (32.3%) underwent a repeat intervention. Mean stent patency time was 67 days (standard deviation=76), and median post-stent survival was 95 days (37-197). Covered and partially covered SEMS carried three times the risk of stent dysfunction compared to uncovered SEMS (odds ratio 3.06, p=0.008). Mortality predictors were Eastern Cooperative Oncology Group score ≥2 (p=0.03), extrinsic outlet obstruction (p=0.05) and presence of ascites (p=<0.001).

Conclusion: SEMS demonstrated technical and clinical success but posed a high risk of recurrence, with stent patency time falling short of survival in our cohort. With an evolving landscape of therapeutics for GOO, appropriate patient selection is paramount. Individuals with reduced performance status, extrinsic obstruction and/or ascites may be better candidates for SEMS due to more limited life expectancy. In this setting, uncovered SEMS carry the lowest risk of reintervention.

Aims: Māori and Pacific peoples in Aotearoa New Zealand experience significant inequities in heart failure rates, treatment and outcomes compared to NZ Europeans. We aimed to understand the experiences of Māori and Pacific people living with heart failure as they navigated care across primary and secondary settings.

Methods: This research involved a secondary analysis of data collected in a wider qualitative study investigating evidence-practice gaps of cardiovascular care experienced by Māori and Pacific people. From the wider pool of semi-structured interviews, we identified 24 people (seven Māori and 17 Pacific peoples, 23 from the North Island) living with heart failure, and applied template and framework analysis to explore their distinct experiences.

Results: Two major themes identified related to participants: 1) Condition-need for more support to understand and self-manage their heart failure condition, and 2) Journey-desire to feel well-connected to the health system in their heart failure journey.

Conclusions: Addressing heart failure inequities for Māori and Pacific peoples requires that providers engage in clear and meaningful communication to support patient self-management. Strengthening pathways for Māori and Pacific patients and whānau (families) between primary and secondary services is required to reduce their likelihood of becoming disconnected from care.

Aim: To evaluate adherence to the New Zealand Major Trauma Destination Policy (MTDP). This audit assessed if, based on their injuries, Emergency Medical Services (EMS) attended major trauma cases were taken to the MTDP determined appropriate hospital. Findings will guide and further improve pre-hospital trauma care and associated patient outcomes.

Methods: A retrospective evaluation of adherence to the New Zealand MTDP for a random sample of 100 cases (ISS >12) injured between 31 November 2017-30 November 2018 who survived to hospital. The EMS electronic patient record (ePRF) was reviewed for each case. Adherence was indicated by the transport of injured patients from the scene to the appropriate initial destination based on meeting the respective regional MTDPs.

Results: Overall, there was a 94% adherence rate to the MTDP. For patients that were not classified as requiring transport to an advanced-level trauma centre, there was a 98.9% (n=86/87) adherence compared to 61.5% (n=8/13) adherence in those that did require transport to an advanced-level trauma centre.

Conclusion: There was high adherence to the MTDP, with 94% of cases being taken to the appropriate destination directly from the incident scene. There is scope for improvement in cases whereby the nearest hospital should be bypassed in favour of a more distant advanced-level trauma centre.

Aim: With an ageing population the prevalence of dementia increases. A healthcare crisis is looming.

Method: Dementia is a terminal condition. The latter, end-of-life phase of this disorder can be very challenging to manage. Patients, whānau and staff may struggle.

Results: Clinical recognition of this phase may be difficult. Determining the appropriateness of medical interventions or palliation, likewise. The clinical load on the acute public hospital services is unbearable. The resources in the aged residential care services are limited.

Conclusions: A pragmatic and reasoned palliative approach by all professionals in the area is advocated.

Aim: This research examines the characteristics and survival outcomes of patients receiving a lung cancer diagnosis after attending the emergency department (ED) of Waikato hospitals in New Zealand.

Methods: This retrospective study was based on a comprehensive database of Waikato patients recorded on the Midland Lung Cancer Register from 2011 to 2021. We compared the characteristics of patients with and without emergency presentations within 14 days before their lung cancer diagnosis. The survival of patients with and without ED attendance was compared between Māori and non-Māori. This study also analysed the odds ratios (OR) of presenting via ED before diagnosis and surviving 12 months based on logistic regressions.

Results: In total, 2,397 patients were included, with 39.6% attending the ED prior to diagnosis. Māori were 1.27 times more likely than non-Māori to be diagnosed after attending the ED. Other characteristics of patients included being male, being diagnosed with small cell lung cancer and having more advanced-stage disease. Patients attending the ED were less likely to survive 12 months than those without ED visits (OR 0.42), and those with two or more ED visits were even less likely to survive 12 months (OR 0.33).

Conclusion: Patients presenting through the ED have more advanced-stage disease, while those presenting through their general practitioners (GPs) have evidence of being diagnosed earlier and having better survival. Barriers to early diagnoses through attendance with a GP, particularly for Māori and for men, need to be explored.