NZMJ 27 March 2015, Vol 128 No 1411; ISSN 1175-8716 THE NEW ZEALAND MEDICAL JOURNAL Journal of the New Zealand Medical Association In this issue: Making industry payments to New Zealand doctors transparent Availability and quantity of antidotes in New Zealand Paediatric EEG provision in New Zealand Electronic cigarettes: nicotine levels http://journal.nzma.org.nz NEW ZEALAND MEDICAL JOURNAL http://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2015/vol-128-no-1411/6490 CONTENTS This Issue in the Journal 4 A summary of the articles featured in this issue Editorials 6 Let the sunshine in: making industry payments to New Zealand doctors transparent Cindy Farquhar, Tim Stokes, Andrew Grey, Mark Jeffery, Peter Griffen 13 Predictors of outcome for cutaneous squamous cell cancer James H F Shaw 20 Availability and quantity of antidotes in New Zealand Leo J Schep, Robin J Slaughter Articles 23 Availability of antidotes, antivenoms, and antitoxins in New Zealand hospital pharmacies John S Fountain, Brendon Sly, Alec Holt, Stephen MacDonell 34 Removal of Special Authority requirements for clopidogrel improved optimal care following percutaneous coronary intervention across sociodemographic groups Suneela Mehta, Sue Wells, Rod Jackson, Jeff Harrison, Andrew Kerr 43 Paediatric EEG provision in New Zealand: a survey of practice Ngaire Keenan, Lynette G Sadlier 51 Computer Assisted Learning for the Mind (CALM): the mental health of medical students and their use of a self-help website Fiona Moir, Antonio T Fernando III, Shailesh Kumar, Marcus Henning, Simon A Moyes, C Raina Elley 59 Predicting lymph node metastases in cutaneous squamous cell carcinoma: use of a morphological scoring system Nicholas J M Agar, Christopher Kirton, Rajan S Patel, Richard C W Martin, Neville Angelo, Patrick O Emanuel 68 Association of point prevalence diagnosis of delirium on length of stay, 6-month mortality, and level of care on discharge at Waitemata District Health Board, Auckland Aik Haw Tan, John Scott 77 Nicotine and toxicant yield ratings of electronic cigarette brands in New Zealand Murray Laugesen Viewpoint 83 What should be the management policy for asymptomatic inguinal hernias? Philip F Bagshaw Clinical Correspondence 89 A rare case of anti-N-methyl-D-aspartate receptor encephalitis during pregnancy Lai Wan Chan, Christer Nilsson, Jan Schepel, Christopher Lynch 92 Medical image. Metal pigmentation of gingiva Makoto Adachi, Yasunori Muramatsu NZMJ 27 March 2015, Vol 128 No 1411; ISSN 1175-8716 Subscribe to the NZMJ: http://www.nzma.org.nz/journal/subscribe © NZMA NEW ZEALAND MEDICAL JOURNAL http://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2015/vol-128-no-1411/6490 Letter 94 The Auckland Surgical Theatre Educational Environment Measure: does attending surgery benefit house officers? Tary Yin, Stephen Child 100 Years Ago in the NZMJ 99 WW1: Prices of Drugs Methuselah 100 Biodegradable stents and coronary artery disease? NZMJ 27 March 2015, Vol 128 No 1411; ISSN 1175-8716 Subscribe to the NZMJ: http://www.nzma.org.nz/journal/subscribe © NZMA NEW ZEALAND MEDICAL JOURNAL http://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2015/vol-128-no-1411/6489 SUMMARIES Availability of antidotes, antivenoms, and antitoxins in New Zealand hospital pharmacies John S Fountain, Brendon Sly, Alec Holt, Stephen MacDonell A survey was conducted of 24 New Zealand hospital pharmacies to identify the levels of antidotes, antivenoms and antitoxins held. Short-comings were identified in the types and quantities of certain of these pharmaceuticals when compared to an international guideline. It was considered that this situation may be improved through national rationalisation of the storage and supply of these drugs and the implementation of a national antidote database. Removal of Special Authority requirements for clopidogrel improved optimal care following percutaneous coronary intervention across sociodemographic groups Suneela Mehta, Sue Wells, Rod Jackson, Jeff Harrison, Andrew Kerr Clopidogrel is a medication that was routinely used until mid-2012 to reduce the risk of clots forming within blood vessels in the heart after percutaneous coronary intervention (a common procedure used to unblock narrowed arteries in the heart). We examined if optimal clopidogrel therapy following percutaneous coronary intervention (PCI) changed by age, sex, deprivation status or ethnic group during and after special authority funding restrictions, which required hospital-specialist approval for full funding. After funding restrictions were lifted, optimal clopidogrel therapy following PCI improved by 7% across all sociodemographic groups. Irrespective of funding restrictions, almost all eligible patients received some clopidogrel therapy and there were few differences in optimal clopidogrel use between men and women, younger and older people and more and less deprived groups. However, Maori and Pacific peoples were less likely to have optimal clopidogrel therapy compared to non-Maori/non-Pacific/non-Indian patients before and after funding restrictions were removed. Paediatric EEG provision in New Zealand: a survey of practice Ngaire Keenan, Lynette G Sadlier Epilepsy is a common disorder affecting ~7300 children in New Zealand. Epilepsy is diagnosed with the help of electroencephalography (EEG), an investigation that looks at electrical activity in the brain. This study investigated the procedures that hospital departments in New Zealand used to record EEGs and interpret EEG results. We found that there is variability between departments in these procedures and increased resources are required to ensure New Zealand children have equal access to EEGs. Computer Assisted Learning for the Mind (CALM): the mental health of medical students and their use of a self-help website Fiona Moir, Antonio T Fernando III, Shailesh Kumar, Marcus Henning, Simon A Moyes, C Raina Elley The CALM website (Computer Assisted Learning for the Mind) was developed to provide skills- training to improve mental health and happiness. The site contains evidence-based resources with much of the content being in the form of audiofiles, so that techniques can be practiced. The CALM website was piloted on a group of New Zealand medical students over a 5-week period. This study showed that students who chose to access the site had higher initial levels of anxiety than students who did not choose to access the site. NZMJ 27 March 2015, Vol 128 No 1411; ISSN 1175-8716 Page 4 Subscribe to the NZMJ: http://www.nzma.org.nz/journal/subscribe © NZMA NEW ZEALAND MEDICAL JOURNAL http://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2015/vol-128-no-1411/6489 Predicting lymph node metastases in cutaneous squamous cell carcinoma: use of a morphological scoring system Nicholas J M Agar, Christopher Kirton, Rajan S Patel, Richard C W Martin, Neville Angelo, Patrick O Emanuel Cutaneous squamous cell carcinoma is common in New Zealand. Usually, the outcome is very favourable for patients with this disease. Rarely, these tumours behave aggressively. We applied a new method of stratifying risk to try and better predict which tumours will behave aggressively and result in a poor outcome. Association of point prevalence diagnosis of delirium on length of stay, 6-month mortality, and level of care on discharge at Waitemata District Health Board, Auckland Aik Haw Tan, John Scott Delirium is common amongst older adults who are hospitalised. This study detects delirium in hospitalised older adults using a test called the Confusion Assessment Method. This study shows that the presence of delirium in hospitalised older adults was associated with an increased likelihood of death within 6 months. It was also associated with a higher chance of being discharged from the hospital to a rest home or private hospital. Nicotine and toxicant yield ratings of electronic cigarette brands in New Zealand Murray Laugesen Electronic cigarettes (e-cigs) contain nicotine but not toxins, and so they do not kill smokers. We checked out 14 brands sold in New Zealand. We found toxic aldehydes had an average concentration of under 0.5% of that found in Marlboro cigarette smoke. Nicotine concentration was one-half to two- thirds that in a Marlboro. E-cigs are comparatively safe to switch to. NZMJ 27 March 2015, Vol 128 No 1411; ISSN 1175-8716 Page 5 Subscribe to the NZMJ: http://www.nzma.org.nz/journal/subscribe © NZMA NEW ZEALAND MEDICAL JOURNAL http://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2015/vol-128-no-1411/6474 EDITORIAL Let the sunshine in—making industry payments to New Zealand doctors transparent Cindy Farquhar, Tim Stokes, Andrew Grey, Mark Jeffery, Peter Griffin Whilst several countries are enacting legislation to tighten requirements for disclosure of the financial ties between pharmaceutical companies and health practitioners, the situation in New Zealand remains as murky as ever. Due to a lack of transparency in New Zealand it is impossible to know to what extent monetary benefits are flowing from industry to health practitioners in the form of sponsored research, conference sponsorship, consulting fees and other financial incentives. Although the presence of the government drug-buying agency PHARMAC makes New Zealand's situation unique, the pharmaceutical industry remains active in promoting its commercial interests to health sector personnel. The time is right for a healthy dose of sunlight to shine on these relationships, with the preferred method being legislation similar to the US Sunshine Act which would provide greater transparency for New Zealand health care consumers. What is the Sunshine Act? The Sunshine Act was first introduced in the United States in 1976 with the aim of improving transparency in the public sector. Initially the act was focused on the federal government, Congress, federal commissions, and other legally constituted federal bodies and was one of a number of Freedom of Information Acts (http://www.gsa.gov/portal/content/102416). In 2007 a proposed amendment to the bill that would have included the health care sector was unsuccessful.