NEW ZEALAND MEDICAL JOURNAL最新文献

Aims: To report the outcomes of patients with neovascular age-related macular degeneration (nAMD) at Palmerston North Eye Clinic (PNEC) during 2020 and 2021, comparing time to treatment initiation based on nurse-injector availability and during COVID-19 restrictions.

Methods: Data were recorded from a prospective database for patients with nAMD at PNEC. Each patient's electronic health record was reviewed to ensure the accuracy of the database and to fill in missing data points. Statistics were done using Microsoft Excel and R.

Results: One hundred and fifty-six eyes were diagnosed with nAMD during the study. Mean time from referral triage to first injection was 13.08 days across the study period. Time to treatment initiation was not statistically different by level of COVID-19 restriction but there was a significant difference in first specialist appointment to injection interval when three nurse-injectors were available compared to four. The effect seemed most evident in subsequent months after reduced nurse-injector availability began.

Conclusions: Despite an increase in nAMD diagnoses each year, PNEC continues to meet national guidelines for interval from referral to treatment initiation through innovations in practice. As demand for intravitreal injections continues to increase, further resourcing and research into newer agents will be required to keep wait times compliant with guidelines.

Aims: The essential components of a rheumatology service for public hospital rheumatology services in Aotearoa New Zealand are not yet defined. We aimed to seek the views of users of public hospital rheumatology services on potential components of a rheumatology service.

Methods: Online survey of adults in Aotearoa New Zealand who self-reported as having used district health board rheumatology services in the past 5 years. Participants indicated their level of agreement (7-point Likert scale) on whether service statements should be a component of public hospital rheumatology services and provided free-text comments. Analysis used descriptive statistics and inductive content analysis.

Results: Over 80% of participants (n=237) agreed or strongly agreed with 23 of the 26 statements about rheumatology care. The three statements that did not reach 80% agree or strongly agreed addressed infusion services for biologic disease modifying anti-rheumatic drugs, offering outpatient assessment for non-inflammatory musculoskeletal conditions and discharge back to primary care when an inflammatory disease is stable. The free-text comments were 1) expression of support of the statement, 2) reconfirming how or why particular services were valued or valuable, 3) caveats about statements, and 4) suggesting other services not mentioned in the statement.

Conclusion: People with inflammatory rheumatic diseases who have used rheumatology services agreed with the majority of the statements of service components, with some caveats. A statement set describing the minimum service expectations for publicly funded rheumatology secondary care in Aotearoa New Zealand has been developed and endorsed by Arthritis New Zealand and the New Zealand Rheumatology Association.

Aim: To investigate use of puberty-blocking hormones (gonadotropin-releasing hormone analogues [GnRHa]) for gender dysphoria in New Zealand. Specifically, to describe demographic characteristics and time trends in the prevalence and incidence of prescribing, and to calculate cumulative incidence (proportion) of first prescribing of GnRHa for gender dysphoria in order to make valid international comparisons.

Method: The national Pharmaceutical Collection was used to identify all dispensing from 2006 to 2023 to those aged <18, by sex/gender and age. Cumulative incidence of first prescriptions between ages 12 and 17 (which largely excludes prescribing for other indications) was calculated and compared with the Netherlands and England and Wales.

Results: In New Zealand, prescription of GnRHa for gender dysphoria started around 2011; prevalence of use increased to 2014, then more steeply to 2022, followed by a decline. Incidence data show the decline started from 2021. New Zealand, compared to the Netherlands (which started prescribing in the 1990s), had 1.7 times the cumulative incidence of first prescriptions by 2018. Compared to England and Wales up to 2020, New Zealand had 3.5-6.9 times the cumulative incidence.

Conclusion: The high rate of prescribing for probable gender dysphoria in New Zealand, and the decline after 2021, require further investigation.

Respiratory arrest secondary to megaoesophagus is a rare complication of achalasia. We treated an 85-year-old female with a history of achalasia who presented with sudden respiratory arrest and cardiopulmonary resuscitation in the community. In the emergency department, she was intubated for respiratory distress secondary to upper airway obstruction and reduced consciousness. Flexible nasal endoscopy revealed a retropharyngeal bulge, and computed tomography (CT) demonstrated megaoesophagus with distal tapering. She was managed with gastric decompression and percutaneous endoscopic gastrostomy (PEG) feeding with an uncomplicated hospital course. This case provides a rare differential for a patient with acute upper airway obstruction and cardiopulmonary arrest and is the first such case described in the literature in Aotearoa New Zealand.

This article makes a case for Māori organisations to investigate developing hospitals in addition to hauora primary care services. Our programme of research on kaumātua hauora has involved ten noho wānanga in Te Tai Tokerau, Waikato and Tauranga Moana. During our wānanga and associated kānohi-ki-kānohi interviews, we heard from older Māori who experienced hospital stays as detrimental to their wellbeing. At a whakahoki kōrero with Waikato kaumātua, we were requested to investigate the rationale for a Māori hospital, a wish that has historical roots in Princess Te Puea Herangi's efforts to create a small hospital at Tūrangawaewae Marae. Her project was stymied by the health authorities of the time. Our observations are backed up by other research demonstrating adverse outcomes for Māori at New Zealand's public hospitals. A small international literature offers some pointers for success in developing hospitals for Indigenous populations. While there are many aspects that would need thorough investigation in a development process (e.g., tikanga, scope, sites, architecture, development finance, cost structures, staffing, clientele and accessibility), we argue that hospitals developed by and for Māori are a long-held dream that could well be enacted in today's health service environment.

Background: There is a lack of literature concerning dermatological conditions affecting patients of Pacific ethnicity.

Aim: To investigate dermatological conditions in patients of Pacific ethnicity referred to dermatology from 2016 to 2022.

Methods: Single-centre study of electronic referrals to dermatology from January 2016 to May 2022.

Results: Pacific ethnicity was recorded for 1.7% of 30,769 referrals to dermatology, under-representing census data for the local population (5.4%). Dermatological diagnoses were eczema in 36% of patients, benign skin lesions in 11% and skin infection in 8.3%.

Conclusion: Eczema was the most common reason for referral to dermatology in patients of Pacific ethnicity in the Waikato Region.