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2021: Here We Come Tēnei Te Whakatau! Te ara tika o te hauora hapori Journal of the New Zealand Medical Association Vol 134 | No 1528 | 15 January 2021 2021: here we come tēnei te whakatau! Remembering past pandemics to ensure we plan for the future: updated New Zealand survey of memorials to the 1918 influenza pandemic Counting the cost of major infection and sepsis in New Zealand: an exploratory study using the National Minimum Data Set Increasing access to contraception Prognostic significance of mid-range Clinician knowledge in New Zealand: assessing the ejection fraction following acute of driving restrictions impact of a new funding initiative coronary syndrome (ANZACS-QI 23) following a stroke event Te ara tika o te hauora hapori 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 Richard Beer Diana Wolken Other enquiries to: NZMA To contribute to the NZMJ, first read: PO Box 156 www.nzma.org.nz/journal/contribute The Terrace Wellington 6140 © NZMA 2021 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 six 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 2020 New Zealand subscription rates Overseas subscription rates Individuals* $349 Individual $486 Institutions $604 Institutions $650 Individual article $33 Individual article $33 *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 15 January 2021, Vol 134 No 1528 ISSN 1175-8716 © NZMA 2 www.nzma.org.nz/journal CONTENTS EDITORIAL 57 7 Prognostic significance 2021: here we come / of mid-range ejection fraction tēnei te whakatau! following Acute Coronary Suzanne Pitama, Tania Huria, Syndrome (ANZACS-QI 23) Cameron Lacey Daniel Chan, Robert N Doughty, Mayanna Lund, Mildred Lee, ARTICLES Katrina Poppe, Andrew J Kerr 10 79 Counting the cost of major infection Radiological imaging of and sepsis in New Zealand: an melanoma: a review to guide exploratory study using the clinical practice in New Zealand National Minimum Data Set Victoria Francis, Tvesa Sehji, Paul J Huggan, Tania A Helms, Mark Barnett, Richard Martin Veronique Gibbons, Katie Reid, Harry Hutchins, Ian Sheerin VIEWPOINTS 26 88 A retrospective analysis Increasing access to of calls to the New Zealand contraception in New Zealand: National Poisons Centre assessing the impact of a new regarding Pacific patients funding initiative Eeva-Katri Kumpula, Rosalina Richards, Orna McGinn, Vicki Mount, Helen Fulcher Pauline Norris, Vanda Symon, Adam C Pomerleau CLINICAL CORRESPONDENCE 35 96 Interviews with health Think about cats in professionals about the National acute vision loss Aaron Yap, Moaz Alshaikhi, Kay Evans Child Protection Alert System Patrick Kelly, Melissa Adam, LETTERS Carmen Basu, Miranda Ritchie, Denise Wilson, Fred Seymour 99 Updated algorithms are 46 required to differentiate type 1 Clinician knowledge from type 2 diabetes using the of driving restrictions Virtual Diabetes Register following a stroke event Lynne Chepulis, Laura Stratton, John Parsons, Christopher Mayo, Ryan Paul Shannon Tisbury, Susan Waterworth, Nicola Starkey NZMJ 15 January 2021, Vol 134 No 1528 ISSN 1175-8716 © NZMA 3 www.nzma.org.nz/journal CONTENTS 103 100 YEARS AGO Are patients diagnosed 115 with functional symptoms during Cheese Mite Itch and ‘code stroke’ receiving best medical Conjunctivitis—A “Minor Horror” of care? the Great War Jaron Huang, Karim M Mahawish PROCEEDINGS 107 DNA information: access, use and 118 implications for healthcare in Proceedings of the Waikato Aotearoa New Zealand Clinical Campus Research Seminar, Sara Filoche, Jon Cornwall Wednesday 14 October 2020 111 ERRATUM Remembering past 123 pandemics to ensure we plan Erratum for the future: updated New Zealand survey of memorials to the 1918 influenza pandemic Nick Wilson, Geoffrey Rice, George Thomson, Michael G Baker NZMJ 15 January 2021, Vol 134 No 1528 ISSN 1175-8716 © NZMA 4 www.nzma.org.nz/journal summaries Counting the cost of major infection and sepsis in New Zealand: an exploratory study using the National Minimum Data Set Paul J Huggan, Tania A Helms, Veronique Gibbons, Katie Reid, Harry Hutchins, Ian Sheerin Infections are a common and growing cause of hospital admission in New Zealand, and a proportion of these admissions are complicated by sepsis. Sepsis (blood poisoning/toto pirau) is what happens when the body’s response to an infection damages its own tissues and organs. Although the exact proportion is unknown, we do know that infections occur more commonly in young children, older adults, people with ‘chronic conditions’ and those who live in areas of economic deprivation. This is the first study in New Zealand to look at the costs of a hospital admission with sepsis. The findings suggest that a quarter of hospital in-patients have an infection that can lead to sepsis. When sepsis develops, it costs $11,000 on average and $13,000 for people who are re-admitted after a sepsis episode, comparable with major trauma. A retrospective analysis of calls to the New Zealand National Poisons Centre regarding Pacific patients Eeva-Katri Kumpula, Rosalina Richards, Pauline Norris, Vanda Symon, Adam C Pomerleau This study aimed to describe contacts to the New Zealand National Poisons Centre (NZNPC) in 2018–2019 relating to Pacific patients. Of all 40,185 patients, Pacific patients comprised 3.4%, non-Pacific 61.9% and people of unknown ethnicities 34.7%. A total of 78.0% of Pacific patients were aged 0–5, 70.4% of exposures were due to child exploratory behaviour, where a child explores their surroundings (eg, putting things in their mouths), and 96.8% occurred in residential settings. Pacific patients were most often exposed to substances commonly found in households. The wellbeing of children and youth is central to the aspirations of Pacific peoples, and the NZNPC service could be a useful resource for families if exposures do occur. Interviews with health professionals about the National Child Protection Alert System Patrick Kelly, Melissa Adam, Carmen Basu, Miranda Ritchie, Denise Wilson, Fred Seymour The National Child Protection Alert System functions in every district health board. It helps health providers share information with colleagues across New Zealand about children where there have been serious concerns about possible maltreatment, so those colleagues may be more likely to provide appropriate help and/or recognise recurrent abuse or neglect. This research describes how the National Child Protection Alert System is regarded by a represen- tative sample of health professionals who work within it and make decisions about whether an alert will be placed. Generally, health professionals regard the system positively, but they identify a number of areas where the system could be enhanced to improve access to infor- mation and reduce any risk of misuse. Clinician knowledge of driving restrictions following a stroke event Laura Stratton, John Parsons, Shannon Tisbury, Susan Waterworth, Nicola Starkey A stroke can have a dramatic and lasting impact on someone’s life and how they think, move and interact with their environment. Driving after stroke can be particularly challenging, but it is often seen as vital to successful rehabilitation. Health professionals working in acute and rehabilitation services are often expected to provide information and advice about driving NZMJ 15 January 2021, Vol 134 No 1528 ISSN 1175-8716 © NZMA 5 www.nzma.org.nz/journal restrictions to people in the early stages following stroke. We surveyed 49 health profes- sionals about their knowledge of New Zealand Transport Agency guidelines for driving after stroke and found that many health professionals have discussions with people about driving restrictions following a TIA or stroke. However, there appears to be limited knowledge of all the restrictions for each condition as they relate to either private or commercial vehicle use. Insufficient training and education for clinicians might explain this gap. Prognostic significance of mid-range ejection fraction following Acute Coronary Syndrome (ANZACS-QI 23) Daniel Chan, Robert N Doughty, Mayanna Lund, Mildred Lee, Katrina Poppe, Andrew J Kerr Previous studies have shown that patients who have suffered a heart attack and who have reduced heart pump function with an ejection fraction of less than 40% have a high risk of dying. In this study, we followed-up over 6,000 New Zealand patients who had a heart attack in 2015. We found that those with mid-range heart pump function with an ejection fraction of 40–50% had a 1.5-fold higher risk of death compared to those with normal ejection fraction, but they had a lower risk compared to those with reduced ejection fraction. Unlike those with reduced ejection fraction following a heart attack, there are no medications that improve outcomes in patients with mid-range ejection fraction.
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