Issue

Vol 132 No 1502: 20 September 2019

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Issue Summary

Article
SUMMARY

What influences clinicians to choose wisely?

Aditya Raina, Michael Ardagh, Belinda Loring

Unnecessary testing in a hospital setting is a global issue and has an impact on patient care as well as health resources. Doctors interviewed at Christchurch Public Hospital believe that there is need to reduce unnecessary testing. In order to accomplish this, making or changing guidelines for testing is not sufficient. Several barriers preventing behavioural change like lack of communication between doctors and lack of knowledge among junior staff about testing must be addressed. Useful strategies for future campaigns could include evidence-based educational presentations to doctors and conducting local audits of unnecessary testing in hospitals.

Article
SUMMARY

Factors influencing protective equipment use by mountain bikers: Implications for injury prevention

Christopher F Pratt, Hannah A Primrose, Mark Fulcher

Injuries appear to be common in mountain biking, and the interest in injury prevention strategies appears to be high in riders and race organisers. The potential benefits, costs and cues have the greatest influence on rider choice of protective equipment. This is important to consider when treating riders and planning injury prevention programmes.

Viewpoint
SUMMARY

The 'H-Bug' epidemic: lessons from antibiotic-resistant staphylococcal outbreaks in New Zealand hospitals from 1955 1963

Deborah Jowitt

New Zealand had its first outbreaks of antibiotic-resistant staphylococcal infection in the mid-1950s. Called the H or Hospital-bug epidemic, these outbreaks affected newborn babies and their mothers in particular. By the 1950s it was already known that over-use of antibiotics would encourage the development of resistant bugs, but doctors had quickly become reliant on these medicines to treat infection. Health officials had little influence on how doctors prescribed, so instead focused on other measures, such as radically changing the way babies were cared for, to reduce infection rates. The lessons of the H-Bug epidemic are still relevant today as multi-drug resistance is a growing problem.

SUMMARY

Poor outcomes in methamphetamine-associated cardiomyopathy a growing health issue in New Zealand

Tom Kai Ming Wang, Shaw-Hua (Anthony) Kueh, Tim Sutton, Ruvin Gabriel, Mayanna Lund, Jen-Li Looi

Methamphetamine use is a growing major health and societal problem. The adverse effects of methamphetamine on the heart are not well recognised or understood. Chronic use of methamphetamine can cause serious damage to the heart resulting in heart failure. Patients with heart failure due to chronic use of methamphetamine have poor prognosis compared to other patients with heart failure due to other causes. This group of patients with heart failure and chronic use of methamphetamine are of young age, male sex, predominantly of Mori ethnicity, and are of high socioeconomic deprivation. Understanding the reasons for the ethnic and demographic differences, as well as addressing the modifiable risk factors such as methamphetamine abstinence, adherence to medications and appointment attendance are critical to preventing and improving outcomes in this condition.

Article
SUMMARY

The strong case for government funding of a polypill for the secondary prevention of cardiovascular disease in New Zealand

Vanessa Selak, Bruce Arroll, Chris Bullen, Rob Doughty, Corina Grey, Matire Harwood, Sue Crengle

Aspirin, statins and blood pressure-lowering medication are recommended for most people who have already had a cardiovascular event (such as a heart attack or stroke) as these medications substantially reduce their risk of having another one. Unfortunately a lot of people are missing out on these medications. One way to improve access to medications is by combining them into a single pill or capsule (a polypill). Despite considerable evidence supporting the safety and effectiveness of polypills for people who have already had a cardiovascular event they are not currently funded by PHARMAC.

Article
SUMMARY

Incidence of stroke and traumatic brain injury in New Zealand: contrasting the BIONIC and ARCOS-IV studies

Suzanne Barker-Collo, Rita Krishnamurthi, Alice Theadom, Kelly Jones, Nicola Starkey, Valery Feigin on behalf of the BIONIC and ARCOS-IV study groups

Traumatic brain injury (TBI) and stroke result in significant disability within our communities and require significant medical input. Understanding the differences in who is at greatest risk and how these risks differ can assist in how prevention programmes are targeted and help ensure funding decisions are evidence based.

Clinical Correspondence
SUMMARY

A rare provocation: a case of extensive pulmonary embolism in a man with previously undiagnosed Klinefelter Syndrome

Olivia Carleton, Frances Mein Smith, Cindy Towns

Klinefelter syndrome (KS) is a rare hormonal condition in men that can cause infertility. There is evidence that it is associated with abnormalities in blood clotting that can lead to an increased risk for blood clots in the legs and lungs. KS is often not diagnosed until adulthood - often when men are trying to start families and can t. This patient was not diagnosed until the age of 50 when he presented with a potentially life threatening blood clot.

Article
SUMMARY

Cardiac disease in pregnancy and the multidisciplinary team: the Wellington experience

Simon M Scheck, Sam Lepine, Olivia Nicholson, Peter Abels, Andrew Aitken

Heart disease in pregnant women is uncommon, however the stresses to the heart during normal pregnancy can pose life-threatening risks to these women. This includes women born with structural abnormalities in the heart, women who have had rheumatic fever, women with abnormal heart rhythms and a range of other conditions. These women with high-risk pregnancies should be seen by a team consisting of cardiologists (heart doctors), obstetricians (pregnancy doctors), anaesthetists and midwives to ensure detailed plans are in place to reduce all risks. When these plans are in place, the risks to the mother can be greatly reduced, allowing these women to have similar outcomes to women without heart disease. Women with heart disease are more likely to have an instrumental (forceps or ventouse) delivery, to shorten the pushing phase of the labour and therefore reduce the strain on the heart. They are no more likely to have a caesarean section. Our study showed no increase in risks to the mother or baby in women with heart disease seen through the clinic compared with the background population.

ALL ARTICLES
SUMMARY
Article
Vol 132 No 1502: 20 September 2019

What influences clinicians to choose wisely?

Aditya Raina, Michael Ardagh, Belinda Loring

Routine pre-operative testing before elective surgery is common.

Article
Vol 132 No 1502: 20 September 2019

Factors influencing protective equipment use by mountain bikers: Implications for injury prevention

Christopher F Pratt, Hannah A Primrose, Mark Fulcher

Injury prevention is a topic of growing interest due to the potential to both reduce morbidity and reduce treatment costs.

Article
Vol 132 No 1502: 20 September 2019

(RETRACTED) Are over-the-counter fish oil supplements safe, effective and accurate with labelling? Analysis of 10 New Zealand fish oil supplements

Julia J Rucklidge, Shelby Hantz, Ian C Shaw

Viewpoint
Vol 132 No 1502: 20 September 2019

The 'H-Bug' epidemic: lessons from antibiotic-resistant staphylococcal outbreaks in New Zealand hospitals from 1955 1963

Deborah Jowitt

When first introduced in the early 1940s, antibiotics proved so effective they quickly instilled general confidence in a ‘once-and-for-all solution’ for infectious diseases.

Letter
Vol 132 No 1502: 20 September 2019

Letter to the Editor: 'The value of frenotomy for ankyloglossia from a parental perspective'

Graham J Sharpe

Re The value of frenotomy for ankyloglossia from a parental perspective.

Methuselah
Vol 132 No 1502: 20 September 2019

Levetiracetam versus phenytoin for second-line treatment of convulsive status epilepticus in children

Phenytoin is the current standard of care for second-line treatment of paediatric convulsive status epilepticus after failure of first-line benzodiazepines

100 Years Ago in the NZMJ
Vol 132 No 1502: 20 September 2019

The Housing Problem

The British Medical Association is not a political body, but must look to politicians for public health legislation.

Proceedings
Vol 132 No 1502: 20 September 2019

Counties Manukau Health Research Week 2019

Dominic Madell

Body composition of New Zealand-born term babies differs by sex and ethnicity

Poor outcomes in methamphetamine-associated cardiomyopathy a growing health issue in New Zealand

Tom Kai Ming Wang, Shaw-Hua (Anthony) Kueh, Tim Sutton, Ruvin Gabriel, Mayanna Lund, Jen-Li Looi

Article
Vol 132 No 1502: 20 September 2019

The strong case for government funding of a polypill for the secondary prevention of cardiovascular disease in New Zealand

Vanessa Selak, Bruce Arroll, Chris Bullen, Rob Doughty, Corina Grey, Matire Harwood, Sue Crengle

Cardiovascular disease (CVD) is one of the major causes of mortality, morbidity and inequities globally.

Article
Vol 132 No 1502: 20 September 2019

Incidence of stroke and traumatic brain injury in New Zealand: contrasting the BIONIC and ARCOS-IV studies

Suzanne Barker-Collo, Rita Krishnamurthi, Alice Theadom, Kelly Jones, Nicola Starkey, Valery Feigin on behalf of the BIONIC and ARCOS-IV study groups

Acquired brain injuries are any injury to the brain occurring after birth

Clinical Correspondence
Vol 132 No 1502: 20 September 2019

A rare provocation: a case of extensive pulmonary embolism in a man with previously undiagnosed Klinefelter Syndrome

Olivia Carleton, Frances Mein Smith, Cindy Towns

Klinefelter syndrome (KS) is an underdiagnosed aneuploidy characterised by an additional X chromosome and hypergonadotrophic hypogonadism.

Letter
Vol 132 No 1502: 20 September 2019

Response to Graham Sharpe re: 'The value of frenotomy for ankyloglossia from a parental perspective'

Sam Illing, Martin Minnee

In response to the letter you have received from Dr Graham Sharpe

Editorial
Vol 132 No 1502: 20 September 2019

New Zealand's big psychotherapy programme requires evaluation

Tarun Bastiampillai, Stephen Allison, David Castle, Ben Beaglehole, Roger Mulder

New Zealand is following the UK and Australia by developing a national psychotherapy programme

Article
Vol 132 No 1502: 20 September 2019

Cardiac disease in pregnancy and the multidisciplinary team: the Wellington experience

Simon M Scheck, Sam Lepine, Olivia Nicholson, Peter Abels, Andrew Aitken

Cardiac disease is becoming increasingly recognised in pregnancy,1 and is the highest cause of maternal death in Australia contributing to 14.3% of maternal mortality.

Article
SUMMARY

What influences clinicians to choose wisely?

Aditya Raina, Michael Ardagh, Belinda Loring

Unnecessary testing in a hospital setting is a global issue and has an impact on patient care as well as health resources. Doctors interviewed at Christchurch Public Hospital believe that there is need to reduce unnecessary testing. In order to accomplish this, making or changing guidelines for testing is not sufficient. Several barriers preventing behavioural change like lack of communication between doctors and lack of knowledge among junior staff about testing must be addressed. Useful strategies for future campaigns could include evidence-based educational presentations to doctors and conducting local audits of unnecessary testing in hospitals.

Article
SUMMARY

Factors influencing protective equipment use by mountain bikers: Implications for injury prevention

Christopher F Pratt, Hannah A Primrose, Mark Fulcher

Injuries appear to be common in mountain biking, and the interest in injury prevention strategies appears to be high in riders and race organisers. The potential benefits, costs and cues have the greatest influence on rider choice of protective equipment. This is important to consider when treating riders and planning injury prevention programmes.

Viewpoint
SUMMARY

The 'H-Bug' epidemic: lessons from antibiotic-resistant staphylococcal outbreaks in New Zealand hospitals from 1955 1963

Deborah Jowitt

New Zealand had its first outbreaks of antibiotic-resistant staphylococcal infection in the mid-1950s. Called the H or Hospital-bug epidemic, these outbreaks affected newborn babies and their mothers in particular. By the 1950s it was already known that over-use of antibiotics would encourage the development of resistant bugs, but doctors had quickly become reliant on these medicines to treat infection. Health officials had little influence on how doctors prescribed, so instead focused on other measures, such as radically changing the way babies were cared for, to reduce infection rates. The lessons of the H-Bug epidemic are still relevant today as multi-drug resistance is a growing problem.

SUMMARY

Poor outcomes in methamphetamine-associated cardiomyopathy a growing health issue in New Zealand

Tom Kai Ming Wang, Shaw-Hua (Anthony) Kueh, Tim Sutton, Ruvin Gabriel, Mayanna Lund, Jen-Li Looi

Methamphetamine use is a growing major health and societal problem. The adverse effects of methamphetamine on the heart are not well recognised or understood. Chronic use of methamphetamine can cause serious damage to the heart resulting in heart failure. Patients with heart failure due to chronic use of methamphetamine have poor prognosis compared to other patients with heart failure due to other causes. This group of patients with heart failure and chronic use of methamphetamine are of young age, male sex, predominantly of Mori ethnicity, and are of high socioeconomic deprivation. Understanding the reasons for the ethnic and demographic differences, as well as addressing the modifiable risk factors such as methamphetamine abstinence, adherence to medications and appointment attendance are critical to preventing and improving outcomes in this condition.

Article
SUMMARY

The strong case for government funding of a polypill for the secondary prevention of cardiovascular disease in New Zealand

Vanessa Selak, Bruce Arroll, Chris Bullen, Rob Doughty, Corina Grey, Matire Harwood, Sue Crengle

Aspirin, statins and blood pressure-lowering medication are recommended for most people who have already had a cardiovascular event (such as a heart attack or stroke) as these medications substantially reduce their risk of having another one. Unfortunately a lot of people are missing out on these medications. One way to improve access to medications is by combining them into a single pill or capsule (a polypill). Despite considerable evidence supporting the safety and effectiveness of polypills for people who have already had a cardiovascular event they are not currently funded by PHARMAC.

Article
SUMMARY

Incidence of stroke and traumatic brain injury in New Zealand: contrasting the BIONIC and ARCOS-IV studies

Suzanne Barker-Collo, Rita Krishnamurthi, Alice Theadom, Kelly Jones, Nicola Starkey, Valery Feigin on behalf of the BIONIC and ARCOS-IV study groups

Traumatic brain injury (TBI) and stroke result in significant disability within our communities and require significant medical input. Understanding the differences in who is at greatest risk and how these risks differ can assist in how prevention programmes are targeted and help ensure funding decisions are evidence based.

Clinical Correspondence
SUMMARY

A rare provocation: a case of extensive pulmonary embolism in a man with previously undiagnosed Klinefelter Syndrome

Olivia Carleton, Frances Mein Smith, Cindy Towns

Klinefelter syndrome (KS) is a rare hormonal condition in men that can cause infertility. There is evidence that it is associated with abnormalities in blood clotting that can lead to an increased risk for blood clots in the legs and lungs. KS is often not diagnosed until adulthood - often when men are trying to start families and can t. This patient was not diagnosed until the age of 50 when he presented with a potentially life threatening blood clot.

Article
SUMMARY

Cardiac disease in pregnancy and the multidisciplinary team: the Wellington experience

Simon M Scheck, Sam Lepine, Olivia Nicholson, Peter Abels, Andrew Aitken

Heart disease in pregnant women is uncommon, however the stresses to the heart during normal pregnancy can pose life-threatening risks to these women. This includes women born with structural abnormalities in the heart, women who have had rheumatic fever, women with abnormal heart rhythms and a range of other conditions. These women with high-risk pregnancies should be seen by a team consisting of cardiologists (heart doctors), obstetricians (pregnancy doctors), anaesthetists and midwives to ensure detailed plans are in place to reduce all risks. When these plans are in place, the risks to the mother can be greatly reduced, allowing these women to have similar outcomes to women without heart disease. Women with heart disease are more likely to have an instrumental (forceps or ventouse) delivery, to shorten the pushing phase of the labour and therefore reduce the strain on the heart. They are no more likely to have a caesarean section. Our study showed no increase in risks to the mother or baby in women with heart disease seen through the clinic compared with the background population.

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