A Measles Epidemic in New Zealand: Why Did This Occur and How Can We Prevent It Occurring Again?
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Journal of the New Zealand Medical Association Vol 132 | No 1504 | 25 October 2019 A measles epidemic in New Zealand: Why did this occur and how can we prevent it occurring again? An open-label feasibility study of repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant depression in the New Zealand healthcare context The burden of alcohol-related presentations to a busy urban New Zealand hospital emergency department Gender and The motivations Erysipelothrix rhusiopathiae bacteraemia in the surgical behind science an immunocompromised host: the unexpected profession denial complication of a crustacean altercation Publication Information published by the New Zealand Medical Association NZMJ Editor NZMA Chair Professor Frank Frizelle Dr Kate Baddock NZMJ Production Editor NZMA Communications Manager Rory Stewart Diana Wolken Other enquiries to: NZMA To contribute to the NZMJ, fi rst read: PO Box 156 www.nzma.org.nz/journal/contribute The Terrace Wellington 6140 © NZMA 2019 Phone: (04) 472 4741 To subscribe to the NZMJ, email [email protected] Subscription to the New Zealand Medical Journal is free and automatic to NZMA members. Private subscription is available to institutions, to people who are not medical practitioners, and to medical practitioners who live outside New Zealand. Subscription rates are below. All access to the NZMJ is by login and password, but IP access is available to some subscribers. Read our Conditions of access for subscribers for further information www.nzma.org.nz/journal/subscribe/conditions-of-access If you are a member or a subscriber and have not yet received your login and password, or wish to receive email alerts, please email: [email protected] The NZMA also publishes the NZMJ Digest. This online magazine is sent out to members and subscribers 10 times a year and contains selected material from the NZMJ, along with all obituaries, summaries of all articles, and other NZMA and health sector news and information. Subscription rates for 2019 New Zealand subscription rates Overseas subscription rates Individuals* $317 Individual $442 Institutions $549 Institutions $591 Individual article $30 Individual article $30 *NZ individual subscribers must not be doctors (access is via NZMA Membership) New Zealand rates include GST. No GST is included in international rates. Note, subscription for part of a year is available at pro rata rates. Please email [email protected] for more information. Individual articles are available for purchase by emailing [email protected] NZMJ 25 October 2019, Vol 132 No 1504 ISSN 1175-8716 © NZMA 2 www.nzma.org.nz/journal CONTENTS EDITORIAL 56 8 The burden of alcohol-related A measles epidemic in presentations to a busy urban New Zealand: Why did this New Zealand hospital emergency occur and how can we prevent it department occurring again? Georgina Svensen, Bridget Kool, Nikki Turner Sarah Buller ARTICLES 67 Wintertime Vitamin D status and 13 its related risk factors among Differing protocols of managing children living in Auckland, adult diabetic ketoacidosis outside New Zealand of the intensive care unit make no Maryam Delshad, Kathryn L Beck, difference to the rate of resolution Cathryn A Conlon, Owen Mugridge, of hyperglycaemia and acidosis Marlena C Kruger, Berit P Jensen, Geo rey Braatvedt, Alfred Kwan, Jing Ma, Pamela R von Hurst Will Dransfield, Catherine McNamara, Cameron Schauer, Steven Miller, VIEWPOINTS Manish Khanolkar 77 24 Gender and the surgical A cost-effectiveness analysis of the profession Prediabetes Intervention Package Angela D McGregor (PIP) in primary care: a 84 New Zealand pilot programme On personal responsibility in Deborah Connor, Kirsten Coppell, medicine Andrew Gray, Trudy Sullivan Helen Ker 35 88 The cost of diabetes-related The motivations behind science hospital care to the Southern denial District Health Board in 2016/17 Alan McLintic Kirsten J Coppell, Shaun J Drabble, Janine A Cochrane, Rosemary A Stamm, 95 Trudy A Sullivan New Zealand needs a comprehensive interpreting 46 service An open-label feasibility study of Ben Gray repetitive transcranial magnetic stimulation (rTMS) for treatment- resistant depression in the New Zealand healthcare context Kate EM Godfrey, Suresh D Muthukumaraswamy, Cathy M Stinear, Nicholas R Hoeh NZMJ 25 October 2019, Vol 132 No 1504 ISSN 1175-8716 © NZMA 3 www.nzma.org.nz/journal CONTENTS CLINICAL CORRESPONDENCE OBITUARIES 99 106 Erysipelothrix rhusiopathiae Kevin Vincent Marriott bacteraemia in an Tim Mason immunocompromised host: the unexpected complication of a 108 Antony Todd Young crustacean altercation Peter Pryor, Andrew Long Eben Jones, Peter Burrell, Tony Barnett, David Lyons-Ewing, Elisabeth Nuttall METHUSELAH LETTERS 110 103 Upadacitinib as monotherapy in Due diligence on today’s patients with active rheumatoid cannabis—a response arthritis and inadequate response Bob McCoskrie to methotrexate 105 100 YEARS AGO Clari cation: a rebuttal to 'The 111 value of frenotomy for ankylo- Operation to Replace the Most glossia from a parental perspective' Important Function of the Anterior Graham J Sharpe Crucial Ligament of the Knee Joint when Rupture of the Ligament has Occurred By JOHN CRAIG, F.R.C.S.I., Consulting Surgeon to Gisborne Hospital NZMJ 25 October 2019, Vol 132 No 1504 ISSN 1175-8716 © NZMA 4 www.nzma.org.nz/journal SUMMARIES Differing protocols of managing adult diabetic ketoacidosis outside of the intensive care unit make no difference to the rate of resolution of hyperglycaemia and acidosis Geo rey Braatvedt, Alfred Kwan, Will Dransfield, Catherine McNamara, Cameron Schauer, Steven Miller, Manish Khanolkar This study has shown that different protocols of insulin infusion in people with type 1 diabetes admitted to hospital with ketoacidosis made no difference to the rate of resolution of the metabolic abnormalities, nor length of hospital stay. A cost-effectiveness analysis of the Prediabetes Intervention Package (PIP) in primary care: a New Zealand pilot programme Deborah Connor, Kirsten Coppell, Andrew Gray, Trudy Sullivan A prediabetes programme delivered by primary care nurses—called the Prediabetes Inter- vention Package (PIP)—was piloted in Hawke’s Bay in New Zealand. The costs and benefi ts of PIP were com-pared with standard care. We found that the intervention is likely to be a cost-effective weight loss strategy for preventing or delaying progression to type 2 diabetes in people with prediabetes. The cost of diabetes-related hospital care to the Southern District Health Board in 2016/17 Kirsten J Coppell, Shaun J Drabble, Janine A Cochrane, Rosemary A Stamm, Trudy A Sullivan We estimated the cost of diabetes hospital admissions to Dunedin Hospital and Southland Hospital for the year 2016/17. There were 6,994 separate diabetes-related hospital admissions costing a total of NZ$41M. Where diabetes was coded as the main reason for hospitalisation the cost was NZ$2.2M, compared with NZ$8M if diabetes was coded as the main underlying reason for hospitalisation. A high proportion of the costs were attributed to cardiovascular disease, eye disease and diseases of the musculoskeletal system, many of which were related to diabetes. Hospital costs are likely to increase as the number of people diagnosed with diabetes increase unless interventions that target preventable diabetes-related admissions and programmes to prevent diabetes are prioritised. An open-label feasibility study of repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant depression in the New Zealand healthcare context Kate EM Godfrey, Suresh D Muthukumaraswamy, Cathy M Stinear, Nicholas R Hoeh A signifi cant number of people in New Zealand struggle with clinical depression. People with clinical depression have diffi culties with employment, maintaining healthy relationships, and have an in-creased risk of suicide. Many people with clinical depression do not respond to treatments with multi-ple trials of medications and talk therapy. Treatment with repetitive transcranial magnetic stimulation (rTMS) is established as a helpful and safe treatment which is widely available internationally. Addi-tionally, rTMS can be safely used in combination with other types of treatment. However, currently the majority of the New Zealand population has almost no realistic way to access rTMS treatment. This study demonstrates that treatment with rTMS can be helpful and safely provided to many people in New Zealand struggling with clinical depression. NZMJ 25 October 2019, Vol 132 No 1504 ISSN 1175-8716 © NZMA 5 www.nzma.org.nz/journal SUMMARIES The burden of alcohol-related presentations to a busy urban New Zealand hospital emergency department Georgina Svensen, Bridget Kool, Sarah Buller This study analysed electronic patient records for adult alcohol-related presentations (ARPs) to a major New Zealand emergency department (ED) for a 12-month period (November 2017 to October 2018). Among 73,381 presentations, 7% were alcohol-related, the majority were male (65%) and aged 20–39 (52%). ARPs were more frequent at night, during the weekends, public holidays and over the summer months. Sixteen percent of injury-related presenta- tions were alcohol-related. ARPs commonly arrived at the ED via emergency services and had a longer length of stay than non-ARPs. Continued public health efforts are required to implement preventative strategies for alcohol-related harm in the ED and society as a whole. Wintertime Vitamin D status and its related risk factors among children living in Auckland, New Zealand Maryam Delshad, Kathryn L Beck, Cathryn A Conlon, Owen Mugridge, Marlena C Kruger, Berit P Jensen, Jing Ma, Pamela R von Hurst This study showed that approximately one-third of our population had vitamin D less than recommendations. Poor vitamin D status during childhood can affect long-term health, so opportunities to intervene during childhood should be pursued. A strong consideration should be given to the high-risk children for whom supplementation may be considered espe- cially in wintertime. Gender and the surgical profession Angela D McGregor Gender imbalance exists in the surgical profession, meaning there are more barriers for women to overcome when pursuing a career in surgery compared to men.