NEW ZEALAND MEDICAL JOURNAL最新文献

Aim: Ambulatory sensitive hospitalisations (ASHs) are hospital admissions for conditions potentially avoidable through timely and effective primary healthcare. ASH rates can indicate healthcare quality and access. This study examines ASH rates among people accessing mental health and addiction (MHA) services in Aotearoa New Zealand.

Method: Retrospective analyses of national MHA service use linked to hospital admission records, compared to total population between 1 July 2012 and 30 June 2018, were conducted. The MHA cohort includes people aged 45-64 with at least one MHA service contact during the study period or 2 years prior.

Results: MHA service users were most commonly hospitalised for angina (26.0%) and chronic obstructive pulmonary disease (COPD; 11.6%). Adjusting for age and ethnicity, the MHA cohort's ASH rate was 2.38 times that of the total population, with higher rates for epilepsy (adjusted rate ratio [ARR]=5.96), COPD (ARR=4.32), diabetes (ARR=3.47) and angina (ARR=2.40).

Conclusion: Findings indicate potentially preventable physical health disparities within and between people accessing MHA services, highlighting the need to improve primary care access. Practice implications include integrated care, prevention and workforce development to reduce ASH and health disparities for people using MHA services.

Aim: Wāhine Connect is a peer-mentoring organisation established in 2017 by a medical clinician to address an unmet need by enabling peer-to-peer wāhine mentorship in medicine and health in Aotearoa New Zealand. This retrospective descriptive study reports the demographic and work profiles of women seeking mentoring, their reasons for seeking mentoring and satisfaction with their experience of the programme.

Methods: Mentees' registration data were analysed to describe demographic characteristics of women seeking mentorship and the reasons women chose to seek mentorship. The survey data on mentorship experience were analysed to describe mentee satisfaction with the Wāhine Connect programme and their mentors.

Results: From October 2017 to December 2023, 642 women participated in the Wāhine Connect mentorship programme. The mean age of mentees was 34 years. The most frequent ethnicities were NZ European (59.8%) and Asian (19.2%). Over 85% of participants were doctors (n=546), with 100 working in primary care and 387 pre-vocationally registered. Of the 39 reasons for accessing mentoring, the three most highly rated were "lack of confidence" (41.6%), "juggling training/work with raising a family" (35.8%) and "balancing your work/career needs with those of your partner" (30.8%). Of 208 respondents to the post-programme evaluation survey, 97.6% rated the value of the mentoring programme as excellent/very good/good, and the quality of the match between mentee and mentor was rated excellent/very good/good by 96.6%.

Conclusions: Women in Aotearoa New Zealand seek mentoring for many reasons and a mentoring service is needed. This need is likely to persist and should be supported by our healthcare system.

Aim: To understand consumers' past experiences with weight management services and explore their conceptions of the ideal weight management programme.

Methods: Three focus groups (n=21) were conducted between November and December 2023, with participants who were waitlisted for metabolic bariatric surgery at Counties Manukau Health New Zealand - Te Whatu Ora. Past experiences with weight management services and ideal features were explored using reflexive thematic analysis. A ranking exercise of 18 potential features in an ideal weight management service was also conducted. Sessions followed Kaupapa Māori principles.

Results: Three main themes centred around service gaps. These were: lack of treatment options and support, weight-related stigma and shame, and psychological issues. Ideal weight management services themes were: increased support from healthcare professionals, group support, funded weight loss medications and metabolic bariatric surgery, a centre for weight management, and flexible programme formats and lengths. In addition to weight loss medications, the top ranked features were peer-support and health coach support.

Conclusion: Participants perceived a general lack of weight management services that are affordable, effective or sustainable and able to address the prevalent underlying mental, social or physical issues associated with excess weight. Participants desired a more holistic, centralised service. This study's findings support the initial model of care by Te Mana ki Tua, a recently initiated specialist weight management service based in Mangere, Counties Manukau.

Aim: We aimed to investigate community systemic antibiotic dispensing in New Zealand across 2010-2019.

Methods: This longitudinal study utilised dispensing data from the National Pharmaceutical Collection and population data from the Health New Zealand - Te Whatu Ora populations web tool. Dispensing rates were measured as the number of defined daily doses/1,000 inhabitants per day (DIDs) and courses dispensed/1,000 inhabitants/year. Dispensing data were stratified by antibiotic group, AWaRe (Access, Watch, Reserve) categories, district health board (DHB) region and patient characteristics.

Results: Between January 1 2010 and December 31 2019, community systemic antibiotic dispensing in New Zealand declined, with courses dispensed dropping from 930 to 782 (average annual change [AAC] -1.9%) and DID from 20.9 to 19.6 (AAC -0.75%). Watch antibiotics decreased by 8% in courses dispensed/1,000 inhabitants/year, with quinolones showing the largest proportional reduction (-37 courses dispensed/1,000 inhabitants/year; AAC -13.4%). Conversely, first-generation cephalosporins increased significantly (+45 courses dispensed/1,000 inhabitants/year; AAC +56%), primarily due to cefalexin. Ethnic differences persisted, with Pacific people consistently exhibiting the highest dispensing rates. Most DHB regions experienced an overall decline in dispensing during this period.

Conclusions: The study identified encouraging trends in antibiotic dispensing, reflecting New Zealand's antimicrobial stewardship initiatives, but also highlighted the rise in cefalexin and ongoing variations that require further investigation.

Aim: We aimed to review the role of functional imaging in cervical cancer to underscore its significance in the diagnosis and management of cervical cancer and in improving patient outcomes.

Methods: This rapid literature review targeting the clinical guidelines for functional imaging in cervical cancer sourced literature from 2017 to 2023 using PubMed, Google Scholar, MEDLINE and Scopus. Keywords such as cervical cancer, cervical neoplasms, functional imaging, stag*, treatment response, monitor* and New Zealand or NZ were used with Boolean operators to maximise results. Emphasis was on English full research studies pertinent to New Zealand. The study quality of the reviewed articles was assessed using the Joanna Briggs Institute critical appraisal checklists.

Results: The search yielded a total of 21 papers after all duplicates and yields that did not meet the inclusion criteria were excluded. Only one paper was found to incorporate the New Zealand context. The papers reviewed yielded results that demonstrate the important role of functional imaging in cervical cancer diagnosis, staging and treatment response monitoring. Techniques such as dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), diffusion-weighted magnetic resonance imaging (DW-MRI), computed tomography perfusion (CTP) and positron emission tomography computed tomography (PET/CT) provide deep insights into tumour behaviour, facilitating personalised care. Integration of artificial intelligence in image analysis promises increased accuracy of these modalities.

Conclusion: Functional imaging could play a significant role in a unified approach in New Zealand to improve patient outcomes for cervical cancer management. Therefore, this study advocates for New Zealand's medical sector to harness functional imaging's potential in cervical cancer management.

Aims: Injury is the leading cause of death for those under 35 years in New Zealand, with major trauma (Injury Severity Score >12) accounting for 2,409 cases in 2021/2022. There is evidence of improved outcomes with specialised trauma care including dedicated trauma admitting teams. Christchurch Hospital introduced a minimally resourced trauma admitting service (TAS) in January 2022. This study evaluates the impact of the implementation of a TAS on the outcomes of major trauma patients.

Methods: A pre-post cohort study compared major trauma patient outcomes at Christchurch Hospital 1 year before and after TAS implementation.

Results: The study included 773 patients-356 pre-TAS and 417 post-TAS. Patient characteristics were similar across both cohorts. No significant differences were found between pre- and post-TAS groups in hospital LOS (7 vs 8 days, p=0.558), in-hospital mortality (6% vs 7%, p=0.774), 30-day mortality (6% vs 7%, p=0.764) or tertiary survey completion (60% vs 60%, p=0.853).

Conclusion: The introduction of the TAS at Christchurch Hospital did not yield objective improvements in major trauma outcomes. Limitations in coverage and staffing may have impacted effectiveness, highlighting the need for better resources and larger studies for further analysis.