Journal of the New Zealand Medical Association Vol 132 | No 1499 | 26 July 2019 Older New Zealanders: addressing an emerging population of hazardous drinkers Doctors’ rights to conscientiously object to refer patients to abortion service providers Unplanned pregnancies of Subsequent injuries experienced What we know, and don’t women with chronic health by Māori: results from a 24-month know, about cannabis, conditions in New Zealand prospective study in New Zealand psychosis and violence 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. 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Individual articles are available for purchase by emailing [email protected] NZMJ 26 July 2019, Vol 132 No 1499 ISSN 1175-8716 © NZMA 2 www.nzma.org.nz/journal CONTENTS EDITORIAL 43 8 Cost and resource implications Older New Zealanders: addressing of introducing intensive nodal an emerging population of surveillance for sentinel node hazardous drinkers positive melanoma in provincial Andy Towers, John McMenamin, New Zealand David Newcombe, Janie Sheridan, Joseph Winstanley, Emma Cervenak, Gillian White Christopher Harmston ARTICLES 49 How much rehabilitation are our 11 patients with stroke receiving? Unplanned pregnancies of women Stephanie Thompson, Annemarei Ranta, with chronic health conditions in Karen Porter, Naomi Bondi New Zealand Bryndl E Hohmann-Marriott VIEWPOINTS 18 56 Three-month use of idarucizumab Point-of-care testing governance at Christchurch Hospital through in New Zealand through the lens the emergency department and of quality: an update on a national MedChartTM regulatory framework Louisa J Sowerby, Jane Vella-Brincat Samarina MA Musaad, Geo rey CE Herd 23 64 Subsequent injuries experienced Doctors’ rights to conscientiously by Māori: results from a 24-month object to refer patients to abortion prospective study in New Zealand service providers Emma Wyeth, Michelle Lambert, Angela Ballantyne, Colin Gavaghan, Ari Samaranayaka, Helen Harcombe, Jeanne Snelling Gabrielle Davie, Sarah Derrett CLINICAL CORRESPONDENCE 36 An audit of patients with a 72 Resistant iron-induced diagnosis of idiopathic pulmonary hypophosphatemia following brosis (IPF) in Canterbury, colorectal surgery New Zealand Yu-Jen Chen, Christopher Lim, James Fulforth, Donna Thomson, Jacob McCormick Gordon Maxwell, Rachel Wiseman, Adrienne Edwards NZMJ 26 July 2019, Vol 132 No 1499 ISSN 1175-8716 © NZMA 3 www.nzma.org.nz/journal CONTENTS LETTERS METHUSELAH 76 83 What we know, and don’t know, A randomised trial of prophylactic about cannabis, psychosis and antibiotics for miscarriage surgery violence Joseph M Boden, Janet K Spittlehouse 100 YEARS AGO 78 84 Sun protection policy in Myositis Ossi cans By New Zealand GORDON MACDONALD, M.D., Dunedin Ben Gray PROCEEDINGS 80 86 The thorny issue of alcohol The proceedings of the 243rd and control in Aotearoa/New Zealand: 244th meetings of the OMSRS developments in Ireland Frank Houghton NZMJ 26 July 2019, Vol 132 No 1499 ISSN 1175-8716 © NZMA 4 www.nzma.org.nz/journal SUMMARIES Unplanned pregnancies of women with chronic health conditions in New Zealand Bryndl E Hohmann-Marriott Unplanned pregnancies can be a health risk for those with chronic health conditions such as diabetes, asthma and depression. In a study of about 7,000 pregnant women in New Zealand, I found that 15% had been diagnosed with a chronic health condition. Nearly half of the preg- nancies of these women with chronic health conditions were unplanned. This was higher than the number of unplanned pregnancies among women without chronic health conditions. Three-month use of idarucizumab at Christchurch Hospital through the emergency department and MedChartTM Louisa J Sowerby, Jane Vella-Brincat Idarucizumab is a high-cost medicine used to reverse the anticoagulant (anti-clotting) medicine dabigatran. We examined the use of idarucizumab from the emergency department and via the prescribing programme MedChart™. We looked at why it was being used and compared this to the national guidelines from PHARMAC and our own guidelines in Hospital HealthPathways. From 12 patients who received idarucizumab, all but one patient had idaru- cizumab prescribed for them according to both PHARMAC and local guidelines. The one exception had been a patient who had accumulated dabigatran in their body so there was high risk for the patient to have a bleed that could not be controlled. Subsequent injuries experienced by Māori: results from a 24-month prospective study in New Zealand Emma Wyeth, Michelle Lambert, Ari Samaranayaka, Helen Harcombe, Gabrielle Davie, Sarah Derrett Māori, the indigenous population of New Zealand, experience a disproportionate burden of injury compared to non-Māori. The impact of injury can be exacerbated by subsequent injuries, ie, injuries that occur after, but not necessarily because of, an earlier injury. Using interview, ACC and hospital discharge data, this study aimed to describe subsequent injuries experienced by Māori to determine: the number and timing of subsequent injury claims reported to ACC in the 24 months following an earlier injury; the proportions of Māori expe- riencing subsequent injuries; and the nature of subsequent injuries. Findings show that 62% of Māori participants who had already experienced a profound injury went on to experience a subsequent injury that reported to ACC within a 24-month period. This suggests that the subsequent injury burden for Māori is considerable, and that preventive opportunities are potentially being missed. NZMJ 26 July 2019, Vol 132 No 1499 ISSN 1175-8716 © NZMA 5 www.nzma.org.nz/journal SUMMARIES An audit of patients with a diagnosis of idiopathic pulmonary brosis (IPF) in Canterbury, New Zealand James Fulforth, Donna Thomson, Gordon Maxwell, Rachel Wiseman, Adrienne Edwards Idiopathic pulmonary fi brosis is a condition of unknown cause which results in progressive reduction in lung function causing breathlessness and often resulting in death. Historically, treatments have been ineffective, but newer agents have shown some promise. This paper highlights the estimated number of patients living with this condition and highlights ways in which resources could be better utilised to help them. Hopefully this may result in better overall care for patients living with this condition. Cost and resource implications of introducing intensive nodal surveillance for sentinel node positive melanoma in provincial New Zealand Joseph Winstanley, Emma Cervenak, Christopher Harmston Patients with melanoma skin cancer which has spread to their lymph glands are normally advised to have a further operation to remove these diseased glands. In the future, this will change because the second operation doesn’t make you live any longer. Instead, health boards will need to follow these patients with regular scans and clinic visits. Here we have calculated the fi nancial cost of this change. It looks to be affordable for the average provincial health board in New Zealand. How much rehabilitation are our patients with stroke receiving? Stephanie Thompson, Annemarei Ranta, Karen Porter, Naomi Bondi New Zealand community stroke rehabilitation guidelines identify how often and how soon after hospital discharge community rehabilitation should start. This service audit looked at how quickly after hospital discharge patients with stroke were seen by a Wellington-based community rehabilitation team, and how much rehabilitation they received in the fi rst four weeks and three months after discharge. We compared this to the guidelines and have made suggestions to improve the service. NZMJ 26 July 2019, Vol 132 No 1499 ISSN 1175-8716 © NZMA 6 www.nzma.org.nz/journal SUMMARIES Point-of-care testing governance in New Zealand through the lens of quality: an update on a national regulatory framework Samarina MA Musaad, Geo rey CE Herd