AIM: This study evaluated functional outcomes months after severe traumatic brain injury (sTBI), and it compared the Corticosteroid Randomisation after Significant Head injury (CRASH) and International Mission for Progno...AIM: This study evaluated functional outcomes months after severe traumatic brain injury (sTBI), and it compared the Corticosteroid Randomisation after Significant Head injury (CRASH) and International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) models. METHODS: This was a retrospective observational cohort study using the Te Manawa Taki (TMT) trauma registry from 1 June 2012 to 31 December 2022. Seventy-nine sTBI patients who had CRASH and IMPACT parameters and Functional Independence Measure (FIM) scores were analysed. A Bland-Altman plot was used to compare the two prognostic calculators. RESULTS: The FIM scores showed 10% severe, 33% moderate and 57% mild disability. Greater Glasgow Coma Scale (GCS) motor score of 1, hypoxia, hypotension, traumatic subarachnoid haemorrhage, petechial haemorrhage and non-evacuated haematoma rates were found in the TMT cohort. Bland-Altman analysis demonstrated good agreement (94.9%) between CRASH and IMPACT overall. The mean bias was -10.09 units, indicating that IMPACT systematically under-estimated CRASH, and hence they are not interchangeable. CONCLUSION: This study highlights functional outcomes of the TMT sTBI cohort. CRASH and IMPACT were good in predicting functional outcome, but because of the systematic bias, we cannot compare the prediction outcome for a patient with CRASH against the prediction outcome of another patient with IMPACT.
AIM: The aim of this article was to evaluate interpreter utilisation during surgical consent processes for Asian patients with limited English proficiency (LEP) at Waikato Hospital, New Zealand. METHODS: We retrospective...AIM: The aim of this article was to evaluate interpreter utilisation during surgical consent processes for Asian patients with limited English proficiency (LEP) at Waikato Hospital, New Zealand. METHODS: We retrospectively analysed clinical data from 540 Asian patients who underwent surgical procedures at Waikato Hospital during 2022 and 2023. Patients were categorised into three English proficiency groups based on clinical documentation: proficient, suspected LEP and definite LEP. We used Chi-squared tests to assess associations between English proficiency, interpreter use and ethnic background. RESULTS: Of 540 patients, 173 (32%) were classified as definite LEP and 14 (2.6%) as suspected LEP. Among definite LEP patients, 136 (78.6%) received interpreter services while 37 (21.4%) did not. No patients with suspected LEP received interpreters. Interpreter use varied significantly across ethnicities, with Indian patients significantly less likely to receive interpreter services compared with non-Indian patients among those with definite limited English proficiency (χ²=7.82, df=1, p=0.005). Definite LEP patients were significantly older (mean 65.4 years) than proficient patients (mean 47.4 years). CONCLUSION: Significant disparities exist in interpreter service provision during surgical consent, particularly affecting Indian patients and those with suspected LEP. These gaps raise concerns about informed consent validity and equitable healthcare access. Systematic improvements in interpreter service protocols and clinician training are needed to ensure compliance with national guidelines and ethical care standards.
AIM: The aim of this article was to describe the use of venoarterial (VA) extracorporeal membrane oxygenation (ECMO) in adults in Aotearoa New Zealand. Survival at 1 year was the primary outcome. Equity of access was a s...AIM: The aim of this article was to describe the use of venoarterial (VA) extracorporeal membrane oxygenation (ECMO) in adults in Aotearoa New Zealand. Survival at 1 year was the primary outcome. Equity of access was a secondary outcome. METHODS: We carried out a retrospective cohort study of all patients undergoing VA ECMO between September 2017 and June 2024 in the Cardiothoracic and Vascular Intensive Care Unit (CVICU) at Auckland City Hospital. The CVICU is the national referral centre for adult VA ECMO in New Zealand. RESULTS: There were 151 patients who received VA ECMO, including 94 (62%) following cardiac surgery and 44 (29%) for cardiogenic shock. Survival to ECMO decannulation, hospital discharge and at 1 year was 114 (76%), 86 (57%) and 80 (53%), respectively. Increased age, non-transplant cardiac surgery and extracorporeal cardiopulmonary resuscitation were associated with decreased survival at 1 year. Major complications occurred in 33/151 (22%) patients and included bleeding in 15/33 (45%) and lower-limb ischaemia in 10/33 (30%). Māori received ECMO at a rate comparable to their population. Of the 144 New Zealand domiciled cases, 13 (9%) were from the South Island. CONCLUSIONS: These outcomes are comparable to international case series. Reduced access by geographic location underscores the need to further develop regional ECMO sub-centres.
INTRODUCTION: Breast cancer is the most diagnosed cancer among women in Aotearoa New Zealand, with incidence rates among the highest globally. Māori and Pacific women experience higher mortality and later-stage diagnosis...INTRODUCTION: Breast cancer is the most diagnosed cancer among women in Aotearoa New Zealand, with incidence rates among the highest globally. Māori and Pacific women experience higher mortality and later-stage diagnosis, reflecting more aggressive cancers, symptomatic detection and systemic barriers to care. Previous projections have not reported results by both ethnicity and region, limiting their use for regional planning. METHODS: Female breast cancer incidence to 2045 was modelled using age-period-cohort Poisson regression, stratified by age, prioritised ethnicity and Health New Zealand - Te Whatu Ora region. Time weights were used to adjust for recent trends, and uncertainty was quantified using 1,000 bootstrap iterations incorporating variation in case counts and population estimates. Age-standardised incidence rates (ASRs) were calculated for observed and projected data. RESULTS: By 2045, annual cases were projected to increase by 47% to 5,243, while the national ASR remained broadly stable at 98.6 per 100,000 (+3.4%). The Northern Region was projected to have the largest absolute increase (+55%), and Te Manawa Taki the largest rise in ASR (+8%). Māori and Pacific women were projected to continue having the highest incidence rates. Māori cases nearly doubled (+91%). Asian women experienced the largest proportional increase in case numbers (+215%), driven by population growth and ageing. CONCLUSION: Breast cancer cases will increase substantially by 2045 despite stable national rates. Ongoing inequities for Māori and Pacific women and rising numbers among Asian women underscore the need for ethnically responsive screening and equity-focussed cancer control strategies. Risk-based approaches may improve detection and manage future screening demand.
AIM: This article extends on a previously published scoping review by describing the what and the how of a specialised, culturally responsive, joint early falls response service practice between occupational therapy and...AIM: This article extends on a previously published scoping review by describing the what and the how of a specialised, culturally responsive, joint early falls response service practice between occupational therapy and paramedics that could enhance falls management and prevention for older adults in Aotearoa New Zealand. METHODS: The research replicated a previous literature search, with critical refinements in search terms and criteria, to identify new or previously overlooked research. Research included was pulled apart to describe an overall model that could be utilised for a local context. RESULTS: Fourteen studies focussing on how occupational therapists and paramedics work together were used. Articles discussed rapid response, early response and hybrid models of service to assess patients and effectively prevent recurrent falls. Articles also included studies on effective falls management and prevention involving occupational therapists following a fall. Grey literature sourced included government reports and healthcare evaluations. These sources informed key considerations for developing a falls response service in Aotearoa New Zealand. CONCLUSION: Investing in a rapid response, interprofessional service would enhance quality of life while easing pressure on emergency and long-term care. Cost-effective, community-based solutions present opportunities to support independence, dignity and wellbeing for an ageing population.
AIM: Our aim was to record current susceptibility results of genital yeast isolates and to compare the results to the previous report covering the period 2001-2015. METHODS: Genital yeast isolates had their antifungal su...AIM: Our aim was to record current susceptibility results of genital yeast isolates and to compare the results to the previous report covering the period 2001-2015. METHODS: Genital yeast isolates had their antifungal susceptibility determined by disc diffusion or minimum inhibitory concentration following standard methods. Sequential isolates from the same person had their initial and last susceptibility results compared. RESULTS: Disc testing was performed on 1,307 initial isolates; 17 (1.3%) were from males. The most frequent isolates were Candida albicans (64%), Nakaseomyces glabratus complex (17%) and Candida parapsilosis complex (7%). While 94% of isolates were susceptible to clotrimazole, susceptibility for other azoles ranged from 62% to 84%. All isolates were susceptible to nystatin. Isolates non-susceptible to one topical azole were often resistant to all azoles tested. For fluconazole, itraconazole and miconazole fewer isolates were susceptible than in the previous time period. The susceptibility to clotrimazole did not change. One hundred and eight women had sequential isolates, range 2-5, collected 1 week to 75 months apart, median 6 months. Four pairs (4%) had a change from susceptible to resistant, all for miconazole, suggesting increased resistance. All latter isolates were susceptible to at least two other azoles and nystatin. CONCLUSIONS: There appears to have been an increase in antifungal resistance to several topical agents used for genital yeast infections. However, in a previously susceptible isolate, treatment failure seldom indicates a change to antifungal resistance. Women with recurrent vulvovaginal yeast infection can be reasonably treated empirically while identification and susceptibility results are awaited.
In this viewpoint we describe two lived experiences of workplace violence. These provide context to introducing the concept of the victim-survivor landscape for frontline healthcare workers. The viewpoint aims to: invite...In this viewpoint we describe two lived experiences of workplace violence. These provide context to introducing the concept of the victim-survivor landscape for frontline healthcare workers. The viewpoint aims to: invite reflection on psychic shifts and disruptions to a healthcare worker's life after experiencing violence; explore consequences of workplace violence; and provoke dialogue on optimal care practices for people who survive violence after such incidents. We acknowledge individual responsibilities and discuss an organisation's role in protecting healthcare workers who experience workplace violence. We emphasise protection of staff, with policies and practices that promote safety within the healthcare system.
The Crown's health workforce reforms, Putting Patients First: Modernising health workforce regulation (PPF),1 emerge in a political climate that is actively dismantling Māori health gains, undermining tino rangatiratanga...The Crown's health workforce reforms, Putting Patients First: Modernising health workforce regulation (PPF),1 emerge in a political climate that is actively dismantling Māori health gains, undermining tino rangatiratanga and reframing equity as "needs not race". Using rapid Tiriti review-an adaptation of critical Tiriti analysis-we assessed the proposal's alignment with Te Tiriti o Waitangi. We found that PPF did not align well with the preamble or the articles of Te Tiriti. There was no equity analysis; no acknowledgement of hauora as taonga, limited Māori involvement in decision making, erasure of tino rangatiratanga and entrenched health inequities were disregarded. These findings highlight systemic silences and risk embedding monocultural practice, weakening accountability and further marginalising kaupapa Māori health models. We recommend that genuine patient-centred regulation must embed Te Tiriti, cultural safety and antiracism into regulatory standards and governance. Without these commitments, health workforce regulation perpetuates rather than remedies inequities, failing Māori and the wider population.
AIM: The aim of this article is to summarise international evidence on the impacts of cultural/ethnic concordance between patients and health professionals and to discuss the implications for New Zealand. METHOD: Databas...AIM: The aim of this article is to summarise international evidence on the impacts of cultural/ethnic concordance between patients and health professionals and to discuss the implications for New Zealand. METHOD: Database searches were conducted from August to September 2025 using Scopus, Embase and PubMed, using key terms related to health outcomes and cultural/ethnic concordance. RESULTS: A total of 25 relevant systematic reviews, meta-analyses and research studies were included for analysis. Overall, evidence is predominately from the United States of America and findings are variable. Cultural concordance is associated with improved communication quality, trust, satisfaction and perceived respect. Concordance is also associated with improved healthcare utilisation, medication adherence and uptake of preventative interventions. Some studies found concordance was associated with differences in clinical decision-making. Impact on clinical outcomes is mixed, with some studies finding concordance has a positive impact on caesarean section rates, diabetes management, surgical outcomes and addiction treatment, while others found no impact. CONCLUSION: Cultural concordance between patients and their health professionals matters, with evidence of impact on patient experience, communication quality, engagement and adherence, clinical decision-making and some clinical outcomes. Findings are inconsistent: the strength of association and groups which see the greatest benefit vary between studies. To reduce health inequities, we need to increase the diversity of the workforce and train all health professionals to provide non-racist, equitable care.
BACKGROUND: Gastric cancer (stomach cancer) is an important contributor to morbidity and mortality in Aotearoa New Zealand, with marked ethnic inequities. Although national incidence rates are declining, Māori and Pacifi...BACKGROUND: Gastric cancer (stomach cancer) is an important contributor to morbidity and mortality in Aotearoa New Zealand, with marked ethnic inequities. Although national incidence rates are declining, Māori and Pacific peoples continue to experience higher rates than other groups. Demographic change and regional population growth are expected to influence future burden, yet no published projections provide estimates disaggregated by ethnicity and region. METHODS: Gastric cancer registrations from 2001 to 2022 from the New Zealand Cancer Registry were linked to population estimates and projections stratified by age, sex, prioritised ethnicity and Health New Zealand - Te Whatu Ora region. Incidence was modelled using an age-period-cohort approach with time-based weighting to emphasise recent trends. Projections to 2045 were generated, and uncertainty was quantified using 1,000 non-parametric bootstrap iterations incorporating perturbation of population denominators. RESULTS: Gastric cancer cases are projected to increase by 47.7% to approximately 725 per year by 2045, despite a decline in the age-standardised rate from 5.9 to 5.3 per 100,000. All regions show increasing absolute numbers, with the Northern Region experiencing the largest rise. Māori and Pacific peoples have the highest current incidence and a large proportional increase in projected cases, although incidence rates decline modestly for all ethnic groups. Future case growth is driven mainly by demographic expansion and an ageing population. CONCLUSION: Absolute gastric cancer cases are projected to increase, particularly among Māori and Pacific populations and in regions experiencing rapid population growth. This has implications for early diagnosis and specialist service delivery. These projections support equity-focussed prevention and service planning, including Helicobacter pylori control, timely diagnostic pathways, and regional planning for specialist cancer services.
AIM: With the reduction in police involvement in front-line mental health responses in New Zealand (implemented November 2024), this study evaluates the primary legal justification supporting paramedics in using force to...AIM: With the reduction in police involvement in front-line mental health responses in New Zealand (implemented November 2024), this study evaluates the primary legal justification supporting paramedics in using force to prevent suicide: Section 41 of the Crimes Act 1961. METHODS: We conducted a qualitative analysis of 20 legal cases (1986-2023) identified through a systematic search. The analysis was structured thematically, focussing on the legal criteria for intervention, the role of de-escalation, the threshold for "reasonable force" and the unresolved conflict between intervention and patient autonomy. Cases were included if Section 41 was central to the legal reasoning or as a justification; cases where Section 41 was cited in passing without substantive discussion were excluded. RESULTS: Case review suggests that while Section 41 can provide a legal justification, its application is highly context dependent. Courts have held that force is justifiable only to prevent immediate and unlawful harm and that it should be proportionate to the threat. Failing to attempt viable, less-restrictive alternatives can render even minimal force unreasonable. Cases involving excessive force demonstrate judicial focus on proportionality and the availability of other options. The analysis highlights a legal and ethical "grey area" concerning patient capacity and the limits of intervention. CONCLUSION: There is limited case law interpreting Section 41 (20 substantive cases identified between 1986 and 2023). To improve safety for patients and practitioners, we suggest clearer operational guidance, multidisciplinary education and consideration of legislative options that would better support healthcare-led responses to mental health emergencies.
AIM: This study aims to describe the epidemiology, clinical features, microbiology and management of paediatric patients (<18 years) admitted to Christchurch Hospital with periorbital or orbital infections over a 10-year...AIM: This study aims to describe the epidemiology, clinical features, microbiology and management of paediatric patients (<18 years) admitted to Christchurch Hospital with periorbital or orbital infections over a 10-year period. METHODS: A retrospective review was conducted of all patients under 18 years admitted with periorbital and orbital infections between 2013 and 2023. Cases were identified using surgical theatre records and discharge coding, with data extracted from electronic medical records. Clinical, demographic, microbiological and management data were analysed descriptively. RESULTS: A total of 495 paediatric cases were identified, with 93% presenting with periorbital cellulitis and 7% with orbital cellulitis. Sinusitis was the predominant predisposing factor for postseptal disease, present in 83% of those cases. Orbital signs such as proptosis, pain with eye movement, reduced visual acuity and ophthalmoplegia were more frequent in orbital cellulitis. Orbital cases had longer hospital stays with a median of 4.5 days (range 2-33 days) compared to periorbital disease with a median of 1 day (range 0-8 days). Orbital cases also had a higher rate of surgical intervention (47%), most commonly functional endoscopic sinus surgery. Staphylococcus aureus was the most frequently isolated organism in both groups (45% periorbital, 42% orbital). Māori and Pacific children were disproportionately affected (comprising 20% and 10% respectively of periorbital cases and 17% and 19% of orbital cases). CONCLUSIONS: The presence of orbital signs should prompt urgent imaging to exclude orbital disease. Sinusitis remains a key risk factor for orbital cellulitis, and Māori and Pacific children are disproportionately affected.
AIM: The aim of this article was to assess agreement between verified self-reported fractures in a clinical trial with Accident Compensation Corporation (ACC) claim data. METHODS: In a 10-year randomised controlled trial...AIM: The aim of this article was to assess agreement between verified self-reported fractures in a clinical trial with Accident Compensation Corporation (ACC) claim data. METHODS: In a 10-year randomised controlled trial of 1,054 women aged 50-60 years, participants self-reported fractures as they occurred or on routine 6-monthly questionnaires. Radiology imaging and reports were used to verify fractures, which were then compared with ACC claims data (ACC is the New Zealand no-fault accident claims organisation funded through levies). Initially, fracture claim data only were obtained, followed by all ACC claims for each participant for the study period. RESULTS: Three hundred and fifty-six self-reported fractures in 248 women were verified in the trial, whereas there were 328 ACC fracture claims from 238 women for the study period. Out of 356 trial fractures, 211 (59%) had a matching ACC fracture claim, and out of 328 ACC fracture claims 211 (64%) had a matching trial fracture. After obtaining all ACC claims, we identified a matching ACC claim for 340/356 (96%) trial fractures: 59% were fracture claims and 31% soft-tissue injury claims. CONCLUSIONS: Repurposing ACC fracture claims data for clinical trials has significant limitations and is likely to introduce false negative and false positive events. When tolerance for misclassification is higher (e.g., large non-randomised studies), ACC claims data may be useful because 60% of claims had a verified fracture, with higher proportions for major fracture types.
AIM: To understand the impacts and responses of households during the Havelock North drinking water outbreak. METHODS: Fifty days after the outbreak, cross-sectional telephone questionnaires were administered to a cohort...AIM: To understand the impacts and responses of households during the Havelock North drinking water outbreak. METHODS: Fifty days after the outbreak, cross-sectional telephone questionnaires were administered to a cohort of households. RESULTS: Seventy-six percent of the people surveyed indicated drinking unboiled tap water, with 35% of those developing diarrhoea, compared with only 3% of those who did not drink the water. Symptoms correlated with increasing quantities of water consumed, and 31% reported a relapse of diarrhoea after initial improvement. The attack rate among those less than 20 years old (41%), was higher than those aged 50 and over (22%). Individuals with diarrhoea had an average of 7 days off school or work. Only 27% of individuals with diarrhoea visited a doctor or hospital, but 72% were in households that purchased items from a pharmacy. Following the issue of a boil water notice, 82% of households boiled their water, and 67% purchased bottled water, with only 5% taking no precautions. A third of the 169 households surveyed continued one or both of these responses for at least 3 weeks after the boil water notice was lifted. CONCLUSIONS: Telephone surveys provided insights into the outbreak not otherwise obtainable from routine surveillance systems, including the attack rates among different demographics, size of the outbreak (5,540 cases within Havelock North), potential of pharmacy-based surveillance, compliance with public health messaging and the need to communicate to households when the water is safe to drink.