AIM: Leptospirosis is a bacterial zoonosis often under-diagnosed due to its presentation as an undifferentiated febrile illness. This study aimed to explore the clinical complexities involved in diagnosing and managing l...AIM: Leptospirosis is a bacterial zoonosis often under-diagnosed due to its presentation as an undifferentiated febrile illness. This study aimed to explore the clinical complexities involved in diagnosing and managing leptospirosis cases in New Zealand. METHOD: Qualitative content analysis of clinical notes from 42 leptospirosis cases used a dual deductive and inductive approach to identify key themes. RESULTS: Three key themes emerged, highlighting the critical role of clinician reasoning in early detection and appropriate clinical response: 1) multiple factors contribute to delayed diagnosis, including incomplete exposure histories and deviation of symptoms from textbook definitions, 2) there were challenges with diagnosis and the use of medication in post-acute care, and 3) interpretation and use of confirmatory tests was inconsistent and complex. Clinicians were confident in suspecting leptospirosis when clinical history taking also assessed relevant exposure. CONCLUSION: Based on these findings, we have made recommendations to prevent delayed diagnosis. We advocate updating clinical references to better reflect New Zealand-specific disease presentation and risk factors to support early diagnosis. National standardisation of diagnostic test timing, selection and interpretation is recommended, alongside clearer notification pathways. Further research could focus on early diagnostic markers to improve clinical decision making in practice.
BACKGROUND: Pelvic exenteration (PE) has evolved from a palliative "procedure of desperation" into a potentially curative operation for selected patients with locally advanced or recurrent pelvic malignancy. Christchurch...BACKGROUND: Pelvic exenteration (PE) has evolved from a palliative "procedure of desperation" into a potentially curative operation for selected patients with locally advanced or recurrent pelvic malignancy. Christchurch Hospital has delivered PE for more than three decades and has been an active contributor to the international development of these procedures. METHODS: Retrospective description of the Christchurch PE programme and its evolution since the mid‑1990s, contextualised against contemporary multicentre evidence, is provided. Service components evaluated include multidisciplinary governance, patient selection, operative strategies for posterior and lateral compartment disease (including sacrectomy), peri‑operative optimisation and survivorship pathways. RESULTS: Since 1995, Christchurch has undertaken over 520 multivisceral pelvic resections. Centralisation of complex patient care supports operative volume, consistency of team performance and benchmarking against international standards. Prospective audits with collaborative international research have strengthened the understanding of what drives good oncological outcomes (particularly the impact of R0 resection), as well as morbidity patterns in high‑risk sub-groups, feasibility of repeat PE and patient‑reported outcomes including quality of life. CONCLUSION: A centralised multidisciplinary programme can safely deliver ultra‑complex pelvic oncology surgery. Continued international collaboration and systematic capture of patient‑reported outcomes will define the next phase of PE service development.
BACKGROUND: Same-day discharge (SDD) following laparoscopic appendicectomy is internationally recognised as safe and effective, yet remains under-utilised in New Zealand. This study evaluates the safety and feasibility o...BACKGROUND: Same-day discharge (SDD) following laparoscopic appendicectomy is internationally recognised as safe and effective, yet remains under-utilised in New Zealand. This study evaluates the safety and feasibility of SDD at Christchurch Hospital. METHODS: A retrospective review of adults undergoing laparoscopic appendicectomy for uncomplicated appendicitis between June 2015 and March 2024 was conducted using data from the SCOPE management system. Patients were divided into SDD (discharged before midnight) and delayed discharge (post-operative days 1-2) groups. The primary outcome was the complication rate (Clavien-Dindo grade ≥3); the secondary outcome was 30-day readmission. RESULTS: Of 2,258 patients, 213 (9.4%) were discharged the same day and 2,045 (90.6%) after at least 1 night. Baseline demographics were similar except for age (32.2 vs 29.9 years, p=0.008) and sex (female 55.1% vs 37.6%, p<0.001). There were no significant differences in complication (0% vs 0.6%, p=0.626) or readmission rates (7.0% vs 6.7%, p=0.775). Morning operations were significantly more likely to result in SDD (74.6% vs 26.3%, p<0.0001). CONCLUSION: SDD after laparoscopic appendicectomy for uncomplicated appendicitis is safe and effective without increasing complications or readmissions. Implementing structured SDD protocols could enhance hospital efficiency and reduce costs.
AIM: Our aim was to determine the 30- and 90-day all-cause mortality of healthcare-associated Staphylococcus aureus bacteraemia (HA-SAB) and determine mortality risk factors. METHOD: We collected HA-SAB events from 1 Jul...AIM: Our aim was to determine the 30- and 90-day all-cause mortality of healthcare-associated Staphylococcus aureus bacteraemia (HA-SAB) and determine mortality risk factors. METHOD: We collected HA-SAB events from 1 July 2022 to 30 June 2024. Patient age, sex, ethnicity and source of HA-SAB were submitted via a secure portal. Patients' National Health Index numbers were matched to the National Minimum Dataset, and 30- and 90-day all-cause mortality was determined. The mortality rate was calculated as a percentage of all HA-SAB events and by age, sex, ethnicity and source. RESULTS: There were 961 HA-SAB events: a rate of 0.15 cases per 1,000 inpatient bed days. Thirty- and 90-day all-cause mortality were 13.8% and 20.7%, respectively. There was no difference in mortality by sex or ethnicity. Mortality increased with age and increased significantly for ≥75 years of age. Invasive medical devices were the source of 70% of HA-SAB events, organs were the source of 12% of HA-SAB events, and surgical site infections were the source of 8% of HA-SAB events. There was no significant difference in mortality by attributable source. CONCLUSION: The 30- and 90-day all-cause mortality associated with HA-SAB is high. The most common sources are vascular access devices. The use of a "care bundle" incorporating proven interventions, applied using a quality improvement framework, should reduce patient harm from these events.
AIMS: The aim of this article was to characterise the mechanisms underlying "breakthrough" ischaemic stroke (IS) or transient ischaemic attack (TIA) despite oral anticoagulation in patients with atrial fibrillation (AF)....AIMS: The aim of this article was to characterise the mechanisms underlying "breakthrough" ischaemic stroke (IS) or transient ischaemic attack (TIA) despite oral anticoagulation in patients with atrial fibrillation (AF). METHODS: We conducted a cross-sectional analysis of adults with non-valvular AF who experienced IS/TIA in the fifth Auckland Regional Community Stroke Study (ARCOS V: September 2020 to August 2021). Using clinical records, we collected data on demographics, comorbidities and peri-event anticoagulant dosing and intake. Anticoagulant adherence in the months preceding IS/TIA was categorised as good control if proportion of days covered (PDC) ≥80% for direct oral anticoagulant users or time in therapeutic range (TTR) ≥70% for warfarin users. IS/TIA mechanism was adjudicated using standardised criteria and classified as cardioembolic or non-cardioembolic, and patient characteristics were compared. RESULTS: Among 179 patients (76/179 [43%] female), 138/179 events (77%) were adjudicated as cardioembolic, while the remainder were attributed to competing mechanisms. Compared with non-cardioembolic events, cardioembolic aetiology was associated with younger median age (72 vs 81 years), lower proportions with good anticoagulant control (87/138 [63%] vs 34/41 [83%], p=0.017) and higher rates of peri-event missed or under-dosing (90/138 [65%] vs 18/41 [44%], p=0.014). In multivariable analysis, good control was independently associated with higher odds of a non-cardioembolic mechanism (adjusted odds ratio 3.67 [95% confidence interval 1.35-9.99], p=0.011). CONCLUSION: Most breakthrough IS/TIA events on oral anticoagulation were either associated with anticoagulant under-exposure (in patients with a cardioembolic aetiology) or a competing mechanism rather than anticoagulant failure. These findings highlight the importance of careful assessment to inform appropriate secondary prevention strategies.
AIM: The aim of this article was to examine clinical and demographic factors associated with receipt of rhythm control procedures (electrical cardioversion [ECV] or ablation) in patients with atrial fibrillation or flutt...AIM: The aim of this article was to examine clinical and demographic factors associated with receipt of rhythm control procedures (electrical cardioversion [ECV] or ablation) in patients with atrial fibrillation or flutter (AF/AFL) in Auckland, Aotearoa New Zealand. METHOD: We conducted a retrospective cross-sectional study of patients with AF/AFL, collecting data up to 31 August 2021. Descriptive statistics were used to characterise procedural use, and associations between patient factors and rhythm control procedures were assessed using multivariable logistic regression. RESULTS: We identified 1,908 patients with AF/AFL (46.8% female), of whom 292 (15.3%) underwent rhythm control procedures (ablation in 109, ECV only 183). In adjusted analysis, increasing age (adjusted odds ratio [aOR] per year 0.96 [95% confidence interval (CI) 0.95-0.97]) and female sex (aOR 0.46 [95% CI 0.34-0.63]) were associated with lower odds of receiving rhythm control procedures. Compared with European patients (New Zealand/other European), Māori (aOR 0.52 [95% CI 0.36-0.77]), Pacific peoples (aOR 0.41 [95% CI 0.28-0.60]) and other ethnicities (aOR 0.47 95% CI 0.28-0.79]) were less likely to undergo rhythm control procedures. The most common indication for rhythm control procedures was symptomatic relief (76.7%) followed by heart failure optimisation (13.7%). CONCLUSION: Rhythm control procedures are selectively applied and vary by demographic and clinical factors. Female sex and ethnicity-based differences highlight the need to understand decision-making and access to rhythm control pathways.
AIM: This study aims to describe the urban-rural disparities in the incidence, demographic features and injury characteristics of trauma admissions in the Te Manawa Taki (TMT) Region of Aotearoa New Zealand. METHODS: A r...AIM: This study aims to describe the urban-rural disparities in the incidence, demographic features and injury characteristics of trauma admissions in the Te Manawa Taki (TMT) Region of Aotearoa New Zealand. METHODS: A retrospective observational study of the TMT trauma cohort was conducted using the data from the TMT trauma registry, which included all severities and all ages between 1 January 2013 and 31 December 2022. The Geographic Classification for Health used in Aotearoa New Zealand was adopted based on the patient's area of domicile into Urban 1, Urban 2, Rural 1, Rural 2 or Rural 3. RESULTS: Rurality was associated with a higher relative risk of trauma, with the incidence rate ratio (IRR) highest for Rural 3 at 2.0 (p<0.01) and 2.7 for major injuries (p<0.05) compared with Urban 1. Falls, road traffic crashes and motorcycle crashes disproportionately affected remote dwellers. Urban dwellers were more likely to sustain injuries from sharps/glass/knives/hand tools (p<0.01). CONCLUSIONS: Urban-rural variations in trauma admissions mainly relate to specific causes of injury, suggesting the need to customise injury prevention interventions for geographic areas. The underlying deprivation of rural areas and the socio-economic status of the demographic need further exploration for their possible modulating role in injury incidence and outcomes.
AIM: We aimed to describe the occurrence and characteristics of vibriosis in Aotearoa New Zealand and the knowledge gaps caused by current disease reporting structures. METHOD: Data on infections involving Vibrio spp. (v...AIM: We aimed to describe the occurrence and characteristics of vibriosis in Aotearoa New Zealand and the knowledge gaps caused by current disease reporting structures. METHOD: Data on infections involving Vibrio spp. (vibriosis) were collated from New Zealand databases recording notifiable diseases, clinical diagnostic results, hospitalisations and deaths (1998-2024). These data were examined for trends and the effects of data collection protocols. RESULTS: V. parahaemolyticus, V. alginolyticus and non-O1/non-O139 V. cholerae were the most common Vibrio spp. reported from gastroenteritis cases and soft tissue infections. Some infections progressed to severe health conditions, including those due to V. vulnificus. The results indicated demographic and clinical trends, but further insights were limited by the lack of comprehensive case data (including exposure information), changes to data generation and collection over time and a decentralised reporting structure. CONCLUSION: Surveillance that captures all infections involving Vibrio spp. and associated metadata would make it possible to establish a baseline disease profile, prioritise health interventions and predict future epidemiological trends.
INTRODUCTION: Mental illness is the second-leading reason for tertiary students in Aotearoa New Zealand to consider dropping out of studies. Meta-analyses report moderate or greater symptoms of depression in 27% and anxi...INTRODUCTION: Mental illness is the second-leading reason for tertiary students in Aotearoa New Zealand to consider dropping out of studies. Meta-analyses report moderate or greater symptoms of depression in 27% and anxiety in 34% of medical students. Rumination has been identified as a transdiagnostic risk factor for anxiety and depression symptoms in medical student populations, but no studies in New Zealand thus far have studied rumination alongside mental health symptoms in tertiary students. METHODS: We conducted an online survey in 2023 to examine the rate of depression and anxiety symptoms, as well as rumination, in a Christchurch-based medical student sample. The survey included demographic questions (gender, ethnicity), the Depression Anxiety Stress Scale 21 (DASS-21) and the Ruminative Responses Scale (RRS), which includes questions on brooding, reflection and depression-related rumination symptoms. RESULTS: One hundred out of a possible 335 (29.9%) medical students completed the survey. Seventy-six were female. Thirty-six percent reported moderate or greater symptom levels of depression, 45% of anxiety and 42% of stress. All RRS subscales were significantly positively correlated with depression, anxiety and stress symptoms. Female students reported significantly more symptoms of anxiety than male students. Asian students reported significantly higher levels of brooding and total rumination than Pākehā students. CONCLUSION: This medical student cohort had concerningly high levels of depression, anxiety and stress symptoms. Rumination is likely an important contributor to negative mental health outcomes. Further research is required to tailor accessible interventions for students with high levels of rumination.
General medicine teams are the largest admitting services in our adult hospitals. However, their limitations in terms of capacity, design and resourcing are well documented. Eating disorders are complex mental health dis...General medicine teams are the largest admitting services in our adult hospitals. However, their limitations in terms of capacity, design and resourcing are well documented. Eating disorders are complex mental health disorders, but when severe they need stabilisation on medical wards. Local guidelines in Wellington currently consider anyone over the age of 16 an adult, yet data show the paediatric hospital to have greater capacity than the adult hospital, which is frequently bed blocked. The paediatric service also has single room design and an eating disorders nurse. We encourage our paediatric colleagues to introduce flexibility into their definitions-in the same way geriatrics does-to better meet the needs of this vulnerable group of young people.
AIM: We aimed to synthesise current evidence on the association between gender-affirming hormone therapy (GAHT) and cancer risk in transgender and gender-diverse (TGD) individuals and to provide evidence-based cancer scr...AIM: We aimed to synthesise current evidence on the association between gender-affirming hormone therapy (GAHT) and cancer risk in transgender and gender-diverse (TGD) individuals and to provide evidence-based cancer screening recommendations for Australasian general practitioners. METHODS: A systematic review of epidemiological studies, case reports and clinical guidelines was conducted in accordance with PRISMA 2020 guidelines. Searches were performed across PubMed/MEDLINE, Embase, Scopus and the Cochrane Library for literature published up to December 2025. Key evidence sources were narratively synthesised to develop practical recommendations tailored to the Australasian context. RESULTS: The available evidence, although limited by short follow-up durations and small cohort sizes, does not demonstrate a consistent, statistically significant increase in common cancers among TGD individuals receiving GAHT. However, emerging case reports highlight novel clinical concerns, including malignancies in surgically constructed tissues (neophallus and neovagina). Breast cancer risk in trans women appears to increase with the duration of oestrogen therapy, though it remains lower than in cisgender women. Prostate cancer may present at a higher grade in trans women receiving oestrogen. Screening participation is consistently lower in TGD populations, often resulting in later-stage diagnoses. CONCLUSION: Cancer screening for TGD individuals should be guided by an organ-inventory approach, based on the organs a person has rather than their gender identity. Clinicians should maintain a low threshold for investigating suspicious lesions, particularly in surgically altered tissues. The development of culturally safe and inclusive primary care environments is paramount to improving screening uptake and ensuring equitable health outcomes for TGD communities in Australia and New Zealand.
AIM: The prevalence of Māori experiencing ngā māuiui kai (eating disorders; NMK) is comparable to that of non-Māori. Despite this, little is known about Māori presentations within Kaupapa Māori health services. This pape...AIM: The prevalence of Māori experiencing ngā māuiui kai (eating disorders; NMK) is comparable to that of non-Māori. Despite this, little is known about Māori presentations within Kaupapa Māori health services. This paper uses Kaupapa Māori kaimahi expertise to describe these presentations and identify steps to strengthen access and support. METHOD: Informed by Kaupapa Māori methodologies and participatory action research, this co-designed study involved Purapura Whetu, a Kaupapa Māori health service in Christchurch. A wānanga convened eight kaimahi to discuss challenges, service strengths and required supports for Māori experiencing NMK. Insights and themes were mapped to the New Zealand Eating Issues and Eating Disorders Strategy to show how Kaupapa Māori approaches can support its implementation. RESULTS: Six themes with 24 actionable points were identified. Themes were: 1) food insecurity, 2) the impact of comorbidities, 3) whānau ora model of practice, 4) access to secondary services, 5) workforce development, and 6) culturally informed screening and assessment tools. These were mapped to the strategy to highlight required actions and their operationalisation. CONCLUSION: While government acknowledgement of Kaupapa Māori services as a key investment area is important, these services and whānau expertise remain underused in policy and commissioning. Achieving health equity for Māori experiencing NMK depends on sustained resourcing and clear implementation priorities.