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‘Public health vandalism: new Government scraps world-leading smokefree legislation’

EDITORIAL

Public health vandalism: new Government scraps world-leading smokefree legislation 

Richard Edwards, Chris Bullen, Janet Hoek, Collin Tukuitonga, Andrew Waa, Natalie Walker 

Summary One of the new Government’s first actions was to announce its intention to repeal New Zealand’s world-leading smokefree legislation. This has created enormous controversy and opposition. The Government’s actions suggest it attaches a low priority to improving population health through prevention and is applying its target-focussed approach highly selectively. Its actions align closely with the tobacco industry’s position of opposing key smokefree policies included in the legislation and show scant regard for the views of New Zealanders. The intention to repeal was not included in the National Party election manifesto and hence the Government lack a democratic mandate for its action, and the decision raises concerns about disproportionate influence of junior coalition partners. Media contact

Professor Richard Edwards: 021870708 Sir Collin Tukuitonga: collin.tukuitonga@auckland.ac.nz

Professor Janet Hoek: 0211506934

ARTICLES

6156. Audit of antimicrobial stewardship in medical inpatients in Waikato, New Zealand 2021 Thomas AC Wong, Mohammed Issa, Cameron Dyer, Jared K Green, Jade AU Tamatea, Gabriella Paoloni, Jessica Hadlow, Hugh McGann

Media contact Thomas Wong, Medical Registrar: 021 178 6633

A/ Hugh McGann, Infectious Diseases Consultant: 027 297 8805

A/ Mohammed Issa, Infectious Diseases Pharmacist: 021 572 592 Summary We describe an audit method using 10 standards in antibiotic prescribing that can be used in individual hospital departments on a regular basis. We audited 205 medical patients in Waikato and Thames Hospitals and found specific areas for improvement for diagnostic testing and antimicrobial stewardship (AMS) in the management of infections. We found similar outcomes for Māori and non-Māori patients. We hope that our findings can contribute to the development of a strong, nation-wide AMS programme for New Zealand.

Vol 136 Issue 1587 15 December 2023

Embargoed until 12.01am

Friday 15 December 2023

6291. Considerations in the assessment and management of ADHD within the TGDNB Population Zoe Kristensen, Caitlyn Drinkwater, Rachel Johnson, David B Menkes

Media contact Dr Zoe Kristensen: zoe.kristensen@waitematadhb.govt.nz 

Summary There is not much research considering ADHD in transgender people specifically, despite it being significantly more common in this group. In this paper we discuss how we might need to assess differently, and considerations as to how gender-affirming treatments might be combined with ADHD treatments. We also identify the potential for progesterone to be used to assist with attention and cognitive issues for ADHD.

6297. A diabetes registrar assisted workflow intervention in general practice for systematic initiation of cardiorenal medications for patients with type 2 diabetes and albuminuria in Aotearoa New Zealand 

Anjana Niyagama, Allan Moffitt, Mahesh Patel, Minnie Strickland, Sara Aprea, Lynne Chepulis, Ryan Paul, Ole Schmiedel, Rinki Murphy

Media contact Prof Rinki Murphy: 021 142 8470

Dr Anjana Niyagama: 022 322 7595

Dr Allan Moffitt: 021 366 772

Dr Mahesh Patel: 0 9 2747823 ext. 9162

Dr Minnie Strickland: 021 862593

Summary 

Chronic kidney disease is a known complication of type 2 diabetes, which manifests as reduction in kidney function and presence of a protein called albumin in urine (albuminuria). Early detection and treatment of this condition with appropriate medications (such as angiotensin-converting enzyme inhibitor/angiotensin receptor blocker [ACEi/ARB], as well as sodium-glucose cotransporter-2 inhibitor [SGLT2i]/glucagon-like peptide-1 agonist [GLP1RA]) are known to improve long-term outcomes of these patients. In this study we looked at whether providing a visiting diabetes registrar in primary care practices in Auckland would help in improving medication prescribing, and it shows an excellent success rate in prescribing new medications to eligible patients. SGLT2i/GLP1A was successfully initiated in 92% and ACEi/ARB was initiated in 89% of the patients. We suggest training registrars to have a primary care placement or to participate in outreach clinics during their training, which will likely provide mutual gains to both training registrars as well as to general practitioners, while providing convenience to the patient to attend at their local clinic.

6183. Key informant perspectives on a centralised contact tracing system for sexually transmitted infections 

Catriona Murray, Sally B Rose, Amanda Kvalsvig, Michael G Baker

Media contact Dr Catriona Murray: 022 412 3135; Catriona144@gmail.com

Summary 

A centralised contact tracing workforce was established in 2020 to help reduce transmission of COVID-19. Given high population STI rates and local research revealing gaps in contact tracing (or partner notification) for STIs, we asked key informants for their views on the utility of a centralised contact tracing service for STIs. There was agreement that more resourcing, support and training is needed for STI contact tracing, with potential benefits of a centralised system including training, standardisation and reduced demand on already stretched clinical services. Drawbacks included trust and privacy concerns, lack of local-level knowledge and the possibility that the needs of priority populations might not be met. Given that high levels of trust are critical to the success of STI contact tracing, this might best be achieved through known local providers who could be supported, as needed, by central expertise.

6311. Raise the Flag I: the impact of a sepsis quality improvement programme on delivery of a sepsis resuscitation bundle at a tertiary hospital in New Zealand 

Katherine M Walland, Paul J Huggan, Camilla Howard, Odette Paul

Media contact Dr Katherine Walland: 021 267 5706

Dr Paul Huggan: 021 685 765 

Summary Sepsis is a life-threatening response to infection. It is a common cause of death and disability in New Zealand, with Māori and Pasifika people, the elderly and those experiencing socio-economic disadvantage most at risk. Urgent administration of simple treatments including bloods tests, intravenous fluids and antibiotics has been shown overseas to save lives. Education and resources focussed on sepsis in Waikato Hospital improved the delivery of these treatments from 50% in 3 hours to 64% in 3 hours. These resources should be ongoing to maintain improvements in sepsis care, as 18 months later the improvements were not sustained.

6359. Who Australasians trusted during COVID-19: Lessons from the pandemic response 

Raven August, Ashleigh Barrett-Young, Hayley Guiney, Sean Hogan, Sandhya Ramrakha, Richie Poulton

Media contact Dr Ashleigh Barrett-Young: 022 021 7517; Ashleigh.barrett-young@otago.ac.nz

Summary 

We investigated which sources of COVID-19 advice were most trusted by a primarily New Zealand-based cohort. Based on data from a COVID-19 vaccine intention survey presented to Australia- and New Zealand-based members of the Dunedin Study, we assessed participants’ trust in specific sources of COVID-19 advice and investigated whether the pattern of responses differed by sex, socio-economic status, or education. We found that doctors and healthcare providers were the most trusted source of COVID-19 advice, above and beyond other institutional sources, regardless of sex, socio-economic status, or education. These findings suggest that doctors and healthcare providers should be empowered by the government to share pandemic advice with the public, to promote a successful pandemic response.

VIEWPOINT

6135. Robot-assisted general surgery in Aotearoa New Zealand 

Phillip P Chao, Jonathan B Koea, Andrew G Hill, David Resoli, Sanket Srinivasa

Media contact Dr Sanket Srinivasa: 020 4080 6487

Dr Phillip Chao: 021 892 421 

Summary 

Robot-assisted surgery refers to a surgeon controlling a robotic device that performs an operation. This viewpoint explores the current state of robot-assisted surgery in Aotearoa New Zealand using the da Vinci surgical system (Intuitive Surgical, Sunnyvale, California, USA), the only currently available robotic surgical system for general surgery in the country. We describe the contemporary progress in Aotearoa New Zealand compared to Australia and globally and present emerging high-level evidence from randomised controlled trials regarding the utility of the robot-assisted approach for general surgery procedures. From the available evidence, we suggest that the value of robot-assisted general surgery in the public healthcare system arises from its emerging clinical benefits for complex procedures and its potential to engender equitable access and outcomes, particularly for Māori and Pacific peoples, improve education and training and contribute towards quality assurance and workforce development. Therefore, its implementation aligns with the New Zealand Health Strategy’s long-term goals and priority areas to achieve pae ora, a healthy future for all.

CASE REPORT

6329. A case of imported rabies in Aotearoa New Zealand 

Hamish Wright, Andrew Fox-Lewis

Media contact Dr Hamish Wright: 027 361 8477

Dr Andrew Fox-Lewis: 022 458 6511 

Summary 

Rabies is a highly lethal viral infection, normally presenting with fever, progressing to agitation, increased saliva production and intolerance of liquids or movement of air, and then coma and death. It is most commonly spread by dog bites, and the majority of cases are acquired in Asia and Africa. This is New Zealand’s first recorded case, having most likely been acquired in the Philippines.

 

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