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5.
N Z Med J ; 133(1512): 15-21, 2020 04 03.
Artículo en Inglés | MEDLINE | ID: mdl-32242174

RESUMEN

BACKGROUND: This is a baseline clinical audit looking at indwelling urinary catheter (IDC) use and trial removal of catheter (TROC) in stroke patients. We collected data on stroke patients admitted to North Shore Hospital between 26 November 2018-24 May 2019, who underwent insertion of an IDC as an inpatient. A minority of patients had TROC within the recommended guideline period. A high incidence of urinary tract infection (UTI) was found in this patient population. Insufficient documentation and inappropriate indications for IDC insertion were features noted during this audit. Daily electronic reminders and prompting by all members of the rehabilitation team concerning TROC are important to reduce catheter days and reduce UTI rates. AIMS: To identify if the trial removal of indwelling urinary catheters (TROC) in stroke patients complies with the 2016 American Heart Association/American Stroke Association (AHA/ASA) AHSA guidelines, and to identify any precipitating factors that prevent compliance with the guidelines. METHODS: We performed a clinical baseline audit that identified patients who were admitted to the acute stroke ward at North Shore Hospital with a diagnosis of stroke from 26 November 2018-24 May 2019 and had an indwelling urinary catheter (IDC) inserted during their admission. The audit consisted of both retrospective and prospective components. Data was collected on patient demographics, the documented indication for IDC insertion, total number of catheter days, the incidence of UTIs and the outcomes after catheter removal. RESULTS: A total of 49 patients were included. 4.1% of patients had catheters removed within 24 hours (95% confidence interval: 0.011-0.137). The average number of catheter days before removal of IDC was approximately five days. 24.5% of our patient sample went on to develop a urinary tract infection. CONCLUSIONS: Insufficient documentation and inappropriate indications for IDC insertion were features noted during this audit. Daily electronic reminders and prompting concerning TROC are important to reduce catheter days and reduce infection rates. Indwelling catheters and associated infections impact the length of hospitalisation, mortality and morbidity of stroke patients.


Asunto(s)
Catéteres de Permanencia , Remoción de Dispositivos , Accidente Cerebrovascular , Cateterismo Urinario , Auditoría Clínica , Femenino , Adhesión a Directriz , Hospitales , Humanos , Masculino , Nueva Zelanda/epidemiología , Estudios Prospectivos , Estudios Retrospectivos , Infecciones Urinarias/epidemiología
7.
N Z Med J ; 133(1513): 81-88, 2020 04 24.
Artículo en Inglés | MEDLINE | ID: mdl-32325471

RESUMEN

AIM: The aims of this study were to describe the variation in volumes and types of injuries admitted to a level one trauma centre in New Zealand over two 14-day periods before and during the national level 4 lockdown for COVID-19; and highlight communities at risk of preventable injury that may impact negatively on hospital resources. METHOD: A retrospective, descriptive study of prospectively collected data in the Midland Trauma Registry in New Zealand. RESULTS: Overall there was a reduction of 43% in all injury-related admissions with significant reductions seen in major injury (50% reduction), males (50% reduction) and children aged 0-14 years (48% reduction). Results for ethnicity and persons aged over 14 years were within 3% deviation of this overall 43% reduction. Injuries at home, particularly falls, predominate. CONCLUSION: Despite the significant reduction in admissions during level 4 lockdown, hospitals should continue to provide full services until resource limitations are unavoidable. Immediate messaging is recommended to reduce rates of injury on the farm and at home, specifically falls prevention. Ongoing attention of road users to road safety is essential to reduce the incidence of preventable major injury. These immediate measures can potentially reduce unnecessary pressure on hospital beds and resources during the pandemic.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Heridas y Traumatismos/epidemiología , Adolescente , Adulto , Betacoronavirus , Niño , Preescolar , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Pandemias , Centros Traumatológicos/estadística & datos numéricos , Adulto Joven
8.
N Z Med J ; 133(1513): 101-106, 2020 04 24.
Artículo en Inglés | MEDLINE | ID: mdl-32325474

RESUMEN

The coronavirus 2019 (COVID-19) pandemic requires significant changes to standard operating procedures for non-COVID-19 related illnesses. Balancing the benefit from standard evidence-based treatments with the risks posed by COVID-19 to patients, healthcare workers and to the population at large is difficult due to incomplete and rapidly changing information. In this article, we use management of acute coronary syndromes as a case study to show how these competing risks and benefits can be resolved, albeit incompletely. While the risks due to COVID-19 in patients with acute coronary syndromes is unclear, the benefits of standard management are well established in this condition. As an aid to decision making, we recommend systematic estimation of the risks and benefits for management of any condition where there is likely to be an increase in non-COVID-19 related mortality and morbidity due to changes in routine care.


Asunto(s)
Síndrome Coronario Agudo/terapia , Infecciones por Coronavirus/epidemiología , Manejo de la Enfermedad , Intervención Coronaria Percutánea , Neumonía Viral/epidemiología , Toma de Decisiones , Humanos , Nueva Zelanda/epidemiología , Pandemias , Resultado del Tratamiento
9.
N Z Med J ; 133(1513): 107-111, 2020 04 24.
Artículo en Inglés | MEDLINE | ID: mdl-32325475

RESUMEN

COVID-19 will be with us through the remainder of 2020 and almost certainly beyond. New Zealand needs a viable strategy to protect its populace until a vaccine is developed and in wide use. Until that time, it makes sense to protect the population by putting in place treatments that will be safe and effective, such as the use of convalescent sera and the use of direct-acting anti-virals. These treatments should be sourced externally or made locally, but steps in this direction must now begin as the lockdown ends. New Zealand has the scientists, the facilities and the will to make this happen, but the support of the government and the population will be needed if this plan is to succeed.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Antivirales/uso terapéutico , Betacoronavirus , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/terapia , Humanos , Inmunización Pasiva , Nueva Zelanda/epidemiología , Pandemias , Neumonía Viral/terapia , Vacunas Virales
12.
N Z Med J ; 133(1511): 52-60, 2020 03 13.
Artículo en Inglés | MEDLINE | ID: mdl-32161421

RESUMEN

AIM: The incidence of venous thromboembolism (VTE) following arthroplasty and hip fracture surgery remains an important metric for quality and financial reasons. An audit at our institution between 2006-2010 showed a higher VTE rate than international data did at the time. This study aims to determine rates of DVT and PE in patients undergoing hip and knee arthroplasty and hip fracture surgery at Waitemata District Health Board (Waitemata DHB) between 1 January 2013 and 31 December 2016. METHODS: This study is a retrospective review of all VTE within three months of elective hip or knee replacement or hip fracture surgery. Data were identified for the period between 2013 and 2016 from Waitemata DHB patient databases, including a dedicated VTE database. RESULTS: The current rates of deep vein thrombosis (DVT) and pulmonary embolism (PE) at our institution following hip or knee arthroplasty or hip fracture surgery are 1.5% and 0.6% respectively, a lower rate than 2.3% and 0.9% respectively in 2006-2010. DVTs were significantly more prevalent after hip fracture surgery than after elective hip or knee arthroplasty, and 71% of DVTs were confined to the distal veins. Of the patients undergoing surgery, 93% received post-operative chemoprophylaxis, mainly aspirin or low molecular-weight heparin (LMWH). CONCLUSION: There has been a significant reduction in VTE rates following elective hip and knee joint replacement and hip fracture surgery between the time periods. This occurred over a period when Waitemata DHB introduced a multi-modal, interdisciplinary team approach to VTE prophylaxis utilising enhanced recovery after surgery (ERAS) pathways. These measures may therefore have contributed to the reduction in VTEs.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Fracturas de Cadera/cirugía , Complicaciones Posoperatorias/epidemiología , Embolia Pulmonar/epidemiología , Tromboembolia Venosa/epidemiología , Trombosis de la Vena/epidemiología , Anciano , Anciano de 80 o más Años , Anticoagulantes/uso terapéutico , Aspirina/uso terapéutico , Femenino , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Incidencia , Masculino , Auditoría Médica , Nueva Zelanda/epidemiología , Procedimientos Ortopédicos , Inhibidores de Agregación Plaquetaria/uso terapéutico , Complicaciones Posoperatorias/prevención & control , Embolia Pulmonar/prevención & control , Tromboembolia Venosa/prevención & control , Trombosis de la Vena/prevención & control , Warfarina/uso terapéutico
13.
N Z Med J ; 133(1511): 61-70, 2020 03 13.
Artículo en Inglés | MEDLINE | ID: mdl-32161422

RESUMEN

AIM: Patients with inflammatory bowel disease (IBD), Crohn's disease (CD) or ulcerative colitis (UC) are at risk of low vitamin D owing to reduced absorption, medication-associated sunlight exposure restrictions and/or increased requirements due to inflammation. This study aimed to determine if the serum vitamin D concentration of New Zealand IBD patients relates to disease activity and differs from controls. METHOD: Data concerning demographics, sunlight exposure, vitamin D supplementation and disease activity were collected using a retrospective questionnaire. Serum vitamin D concentrations were measured in dried blood spots and validated against blood samples in a participant sub-group. RESULTS: Vitamin D concentration was significantly increased by supplementation (82.8 v 66.4nmol/L, p<0.001) and sunlight exposure while on holiday (75.2 v 63.7nmol/L, p<0.001). Patients with CD who reported active disease in the last year had significantly lower vitamin D concentrations (68.6 v 84.6nmol/L, p=0.008) than those who reported remaining in remission. CONCLUSION: In this cohort of New Zealand residents, mean vitamin D of patients with IBD was not different from controls. In patients with CD, recent disease activity was significantly associated with lower vitamin D. The use of vitamin D supplementation may have implications for reducing disease activity occurrence in patients with CD.


Asunto(s)
Enfermedades Inflamatorias del Intestino/epidemiología , Deficiencia de Vitamina D/epidemiología , Vitamina D/análogos & derivados , Adulto , Estudios de Casos y Controles , Colitis Ulcerosa/sangre , Colitis Ulcerosa/epidemiología , Enfermedad de Crohn/sangre , Enfermedad de Crohn/epidemiología , Femenino , Humanos , Enfermedades Inflamatorias del Intestino/sangre , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Vitamina D/sangre , Deficiencia de Vitamina D/sangre
15.
N Z Med J ; 133(1509): 9-16, 2020 02 07.
Artículo en Inglés | MEDLINE | ID: mdl-32027634

RESUMEN

AIM: The purpose of this paper is to assess whether screening for myopia in New Zealand is valid under scrutiny of the Wilson and Jungner criteria. There is a worldwide myopia epidemic which requires urgent attention to reduce vision impairment, blindness and costs to wider society. The risks associated with myopia are under-appreciated in New Zealand, and treatments need to be refocused from correcting refractive error to preventing axial length elongation. METHODS: The Wilson and Jungner criteria was used to assess the validity of screening for myopia in New Zealand through review of the latest evidence relevant to each point within the criteria. RESULTS: We found that the screening for myopia in New Zealand met 7 out of 10 of the Wilson and Jungner criteria. CONCLUSIONS: The concept of a screening programme for myopia in New Zealand performed relatively well, and should be considered further. Further randomised clinical trials, which clearly identify the appropriate treatment modalities and timing, would allow the establishment of robust New Zealand specific myopia management guidelines. We would then suggest a trial of a screening programme in New Zealand setting to assess real-world feasibility and cost-effectiveness to identify early myopia and provide treatment to slow progression. Adjustments could be made to the already available screening programme, consisting of suitable reduction of screening age, and introduction of autorefractors.


Asunto(s)
Tamizaje Masivo/normas , Miopía/diagnóstico , Niño , Preescolar , Humanos , Miopía/epidemiología , Nueva Zelanda/epidemiología , Prevalencia , Reproducibilidad de los Resultados , Pruebas de Visión , Agudeza Visual
16.
N Z Med J ; 133(1509): 28-38, 2020 02 07.
Artículo en Inglés | MEDLINE | ID: mdl-32027636

RESUMEN

AIM: To determine the contribution of smoking-related deaths to the life expectancy gap in both Maori and Pacific people compared with non-Maori/non-Pacific people in New Zealand. METHODS: Death registration and population data between 2013 and 2015 were used to calculate life expectancy. To determine the contribution of smoking to the life expectancy gap, population attributable fractions for all causes of death where smoking is a casual risk factor were calculated using age- and ethnic-specific smoking data from the 2013 New Zealand Census and relative risk estimates from the American Cancer Society Cancer Prevention Study II. Population attributable fractions were applied to all deaths registered in New Zealand for the 2013-15 period to estimate the number of deaths attributable to tobacco smoking. The life expectancy gap was decomposed using the Arriaga method. The gap was decomposed both overall and by specific smoking attributable causes of death. RESULTS: Between 2013 and 2015 an estimated 12,421 (13.4% of all deaths) were attributable to smoking. Nearly one in four (22.6%) deaths among Maori were attributable to smoking (2,199 out of 9,717 deaths) and nearly one in seven (13.8%) among Pacific people (512 out of 3,720 deaths). Among non-Maori/non-Pacific people, one in eight (12.3%) deaths were attributable to smoking (9,710 out of 78,759 deaths). Higher rates of smoking attributable mortality were responsible for 2.1 years of the life expectancy gap in Maori men, 2.3 years in Maori women, 1.4 years in Pacific men and 0.3 years among Pacific women. Cancers of the trachea, bronchus and lung, chronic obstructive pulmonary disease (COPD) and ischaemic heart disease were the leading smoking attributable causes of death contributing to the gap. CONCLUSION: Smoking is an important preventable risk factor contributing to ethnic inequities in life expectancy for Maori men and women, and Pacific men. Dramatic declines in smoking-attributable deaths can be achieved by reducing smoking prevalence rates. Preventing smoking initiation and increasing cessation rates must remain a top priority for the Ministry of Health and District Health Boards. Smokefree initiatives should be reoriented to be Tiriti o Waitangi (Treaty of Waitangi) compliant and better meet the needs of Maori and Pacific people who smoke. Addressing the residual risk in ex-smokers through equitable early diagnosis and treatment of smoking-related conditions will further assist a more rapid closing of life expectancy gaps for Maori men and women and Pacific men. The next five years provide the opportunity to demonstrate commitment to achieving a smokefree Aotearoa for all: an aspiration, based on the current trajectory, which is most probably out of reach.


Asunto(s)
Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Disparidades en el Estado de Salud , Esperanza de Vida/etnología , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Fumar Tabaco/etnología , Femenino , Humanos , Masculino , Nueva Zelanda/epidemiología , Fumar Tabaco/epidemiología
17.
N Z Med J ; 133(1509): 47-57, 2020 02 07.
Artículo en Inglés | MEDLINE | ID: mdl-32027638

RESUMEN

AIM: To investigate the epidemiology of traumatic spinal cord injury (TSCI) in New Zealand over a 10-year period. METHODS: Ambispective data of all new patients admitted to New Zealand's two spinal rehabilitation units between January 2007 and December 2016 (n=929) were collated. Variables assessed included age at injury, gender, ethnicity, date of injury, aetiology, length of hospital stay, injury level, neurological status on discharge and discharge destination. RESULTS: The incidence of TSCI averaged 22 (95% CI 21-24) per million, increasing 6% a year. The average incidence for Maori (29 per million people (95% CI 25-34)) was 1.8 times higher than New Zealand European (16 per million people (95% CI 15-18)), and show an increase of 14% a year. The median age of TSCI increased from 43 to 48 years. Overall, falls (32%), transport (32%) and sports (22%) were the most common causes of TSCI. Cervical TSCI (54%) were most common, particularly in older adults (70% over 75 years) and Maori (61%) and Pacific Island (72%) patients. Surgical rates remained stable (77%) but length of stay in hospital decreased over the study period. CONCLUSIONS: The demographic of TSCI is changing in New Zealand. The median age of patients is increasing, as is the incidence, particularly for women, older adults and Maori patients.


Asunto(s)
Accidentes por Caídas/estadística & datos numéricos , Accidentes de Tránsito/estadística & datos numéricos , Traumatismos en Atletas/epidemiología , Traumatismos de la Médula Espinal/epidemiología , Violencia/estadística & datos numéricos , Actividades Cotidianas , Adolescente , Adulto , Distribución por Edad , Anciano , Vértebras Cervicales , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Humanos , Incidencia , Tiempo de Internación/estadística & datos numéricos , Vértebras Lumbares , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/estadística & datos numéricos , Nueva Zelanda/epidemiología , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Sistema de Registros , Distribución por Sexo , Traumatismos de la Médula Espinal/etnología , Traumatismos de la Médula Espinal/fisiopatología , Traumatismos de la Médula Espinal/cirugía , Vértebras Torácicas , Adulto Joven
18.
N Z Med J ; 133(1510): 35-44, 2020 02 21.
Artículo en Inglés | MEDLINE | ID: mdl-32078599

RESUMEN

AIMS: To determine whether glycaemic control and the prevalence of microvascular complications in Waikato children/youth with type 1 diabetes (T1D) has changed since 2003. METHODS: A retrospective review was performed of clinical records of children and youth with T1D who were under the care of the Waikato Paediatric and Young Adult Diabetes Services between March 2016 and March 2017. Comparisons were made to published data from the same service in 2003. RESULTS: Despite a more than two-fold increase in insulin-pump therapy since 2003, glycaemic control was not significantly improved in either children or youth. However, since 2003 there has been a significant reduction in the prevalence of diabetic retinopathy (24.6% vs 6.0%; P=0.003) and nephropathy (6.0% vs 25.4%; P=0.002), while symptomatic diabetic neuropathy remains rare. This reduction occurred despite a significant increase in obesity and hypertension, and no significant difference in the rates of dyslipidaemia or smoking. CONCLUSIONS: There has been a marked reduction in microvascular complications in Waikato youth and young adults with type 1 diabetes, but the reasons for the reduction are not clear given there has been no significant improvements in glycaemic control.


Asunto(s)
Diabetes Mellitus Tipo 1/complicaciones , Nefropatías Diabéticas/etnología , Neuropatías Diabéticas/etnología , Retinopatía Diabética/etnología , Grupo de Ascendencia Oceánica , Adolescente , Biomarcadores/sangre , Glucemia/metabolismo , Niño , Preescolar , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 1/etnología , Nefropatías Diabéticas/etiología , Neuropatías Diabéticas/etiología , Retinopatía Diabética/etiología , Femenino , Humanos , Hipoglucemiantes/uso terapéutico , Lactante , Recién Nacido , Masculino , Nueva Zelanda/epidemiología , Prevalencia , Estudios Retrospectivos
19.
N Z Med J ; 133(1510): 62-69, 2020 02 21.
Artículo en Inglés | MEDLINE | ID: mdl-32078602

RESUMEN

AIMS: National responses to antimicrobial resistance (AMR) require an understanding of the factors driving its development and spread. Research to date has primarily focused on determining individual-level risk factors for AMR-associated infections. However, additional insights may be gained by investigating exposures associated with AMR variation at the population level. METHODS: We used an ecological study design to describe the association between the incidence rate of methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum ß-lactamase producing Escherichia coli (ESBL-E. coli) infection and population-level variables among 18 geographically distinct populations, defined by district health boards, in Aotearoa New Zealand. Associations were described using Spearman's correlational analysis. RESULTS: Positive correlations were found between the incidence of both MRSA and ESBL-E. coli infection and household crowding and community antimicrobial use. Positive correlations were also observed between MRSA and socioeconomic deprivation; age <5 years; Maori ethnicity; and Pacific ethnicity. For ESBL-E. coli, positive correlations were also observed with Asian ethnicity; Pacific ethnicity; and overseas-born new arrivals. European ethnicity was negatively correlated with both MRSA and ESBL-E. coli infection. CONCLUSIONS: These findings provide insight into the potential contribution of population-level exposures to MRSA and ESBL-E. coli infection in New Zealand. Exposures such as household crowding, community antimicrobial use and socioeconomic deprivation, are in principle modifiable and may present potentially novel opportunities to reduce the burden of AMR.


Asunto(s)
Infecciones por Escherichia coli/epidemiología , Escherichia coli/enzimología , Staphylococcus aureus Resistente a Meticilina , Infecciones Estafilocócicas/epidemiología , beta-Lactamasas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Infecciones por Escherichia coli/microbiología , Infecciones por Escherichia coli/transmisión , Femenino , Encuestas Epidemiológicas , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Vigilancia en Salud Pública , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/transmisión , Adulto Joven
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