Mixed gender accommodation: prevalence, trend over time and vulnerability of older adults.

Admitting male and female patients to the same room compromises the safety of female patients and violates the rights of all patients. We demonstrate that mixed bedding is common (47.22% of admissions), increasing and disproportionately affects vulnerable older patients in a large New Zealand hospital from 2011 to 2019 (n = 160 048). Eliminating mixed bedding should be a priority for our hospital system.

Opioid Utilization and Perception of Pain Control in Hospitalized Patients: A Cross-Sectional Study of 11 Sites in 8 Countries.

BACKGROUND: Hospitalized patients are frequently treated with opioids for pain control, and receipt of opioids at hospital discharge may increase the risk of future chronic opioid use. OBJECTIVE: To compare inpatient analgesic prescribing patterns and patients' perception of pain control in the United States and non-US hospitals. DESIGN: Cross-sectional observational study. SETTING: Four hospitals in the US and seven in seven other countries. PARTICIPANTS: Medical inpatients reporting pain. MEASUREMENTS: Opioid analgesics dispensed during the first 24-36 hours of hospitalization and at discharge; assessments and beliefs about pain. RESULTS: We acquired completed surveys for 981 patients, 503 of 719 patients in the US and 478 of 590 patients in other countries. After adjusting for confounding factors, we found that more US patients were given opioids during their hospitalization compared with patients in other countries, regardless of whether they did or did not report taking opioids prior to admission (92% vs 70% and 71% vs 41%, respectively; P < .05), and similar trends were seen for opioids prescribed at discharge. Patient satisfaction, beliefs, and expectations about pain control differed between patients in the US and other sites. LIMITATIONS: Limited number of sites and patients/country. CONCLUSIONS: In the hospitals we sampled, our data suggest that physicians in the US may prescribe opioids more frequently during patients' hospitalizations and at discharge than their colleagues in other countries, and patients have different beliefs and expectations about pain control. Efforts to curb the opioid epidemic likely need to include addressing inpatient analgesic prescribing practices and patients' expectations regarding pain control.

Extensively drug-resistant tuberculosis: New Zealand's first case and the challenges of management in a low-prevalence country.

In 2010, an immigrant from Burma was the first person to be diagnosed in New Zealand with extensively drug-resistant tuberculosis (XDR-TB). The strain of Mycobacterium tuberculosis is the most resistant reported to date in Australasia. Key difficulties of managing this disease in a low-prevalence country were delays from drug-susceptibility testing and in acquiring appropriate medicines, and a lack of evidence-based guidelines. Solutions are needed for New Zealand and the wider region as more cases of XDR-TB are likely to be encountered in the future.

Stem cells: public policy and ethics.

Debate on the regulation of human stem cells needs to bring together scientific, ethical and policy considerations if it is to be adequately informed. Scientific issues of importance include the relevance of the environment in appreciating the extent of stem cell plasticity, and the relative potential of embryonic and adult stem cells to produce other cell types. An awareness that blastocysts (early embryos) and stem cells in the laboratory are pluripotential and not totipotential has implications for ethical and policy debate. The regulations on stem cell research are reviewed, showing that four positions have emerged. Position A corresponds to the prohibition of all embryo research, position B confines the use of embryonic stem cells to those currently in existence and therefore extracted prior to some specified date, position C allows for the use and ongoing isolation of embryonic stem cells from surplus in vitro fertilization embryos, and position D approves of the creation of human embryos specifically for research. Position B which has been adopted by the United States, Germany, and Australia (with subtle differences between them) and which is regarded as a compromise position, is critiqued. This is principally on the basis that, in spite of claims made about it, the ongoing destruction of human embryos will continue. This is because these countries allow in vitro fertilization programs, inherent within which is embryo destruction. It is argued that position C would be a more consistent ethical position for these countries. The possibility of moving to position D is also raised.