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In June 2020 the Office of the Auditor-General released its report on the management of personal protective equipment (PPE) in New Zealand during the COVID-19 pandemic. The report raises three issues of ethical concern inadequate stock, inequity and complacency. Acting on the report's recommendations is a critical step in strengthening New Zealand's preparedness for future public health crises.The Health and Disability Code precludes any research involving a competent patient without the informed consent of the participant. A learning health system requires rigorous evaluation of both new and established clinical practice, including low-risk components of usual care pathways. When comparing two accepted practices, the only way to control for unknown confounders is by randomisation. In some limited circumstances, particularly when comparing groups or clusters of patients, this comparison can only practicably be undertaken without consent. The current Code impedes a learning health system and is detrimental to the health of New Zealanders. It urgently needs updating.In the older generations, cognitive impairment and wealth are both increasing. Doctors routinely assess decisional capacity in health matters yet are less adept in the assessment of other domains. Recent New Zealand Court decisions will likely result in increased requests by lawyers for contemporaneous medical assessments of the capacity to make a will. The clinical assessment is underpinned by the legal test for testamentary capacity. A psychogeriatrican and a barrister explain the principles and the clinical application. Careful assessments could protect the older adult and minimise the risk of a contested will after death.Myocardial infarction with non-obstructive coronary arteries (MINOCA) is an increasingly recognised condition and it accounts for approximately 10% of all cases of MI. Despite the absence of obstructive coronary artery disease, patients with MINOCA are at increased risk of morbidity and mortality compared to the general population. While many well recognised conditions can present as MINOCA, it can be difficult to reach a final diagnosis with certainty due to the relative infrequency of these conditions in the general population and the lack of diagnostic gold-standard tests. The most common causes of MINOCA are myocarditis, coronary vasospasm, coronary plaque disruption and coronary thrombus or embolism. These can be assessed by way of cardiac magnetic resonance imaging, intra-coronary imaging modalities and clinically relevant diagnostic blood tests, respectively. There are less common and rarer aetiologies which should be considered in the absence of an apparent cause, each with a unique diagnostic standard. By following a systematic approach of diagnostic tests, an underlying cause of MINOCA can be found in the majority of cases, allowing a directed management strategy to be pursued.Dementia is recognised to be one of the most challenging diseases facing society, both now and in the future, with its prevalence estimated to increase substantially by 2050. The potential contributions of age-related sensory deficits have attracted little attention until recently, when a landmark study suggested that hearing loss could be a greater risk factor for dementia than hypertension, obesity, smoking, depression, physical inactivity or social isolation. Over the last decade, evidence has been gradually accumulating to suggest that the other part of the inner ear, the balance organs or 'vestibular system', might also be important in the development of cognitive dysfunction and dementia. Increasing evidence suggests that dizziness associated with vestibular dysfunction, a common reason for patients consulting their GPs, increases the risk of cognitive dysfunction, including dementia, and our understanding of the basic neurobiology of this sensory system supports this view. This paper aims to review and critically evaluate the relevant evidence.
To determine what patients presenting to general practice (GP) understand about the use of cannabis as a medicine, beliefs of how this may impact their medical conditions and interactions with doctors.

An in-person survey of 134 GP patients from four GP practices throughout the North Island of New Zealand undertaken from November 2018 to October 2019.

Fifty-five percent of the sample were female, with 40% of all participants aged 60 years plus. Ninety-one percent of participants indicated they would use a prescribed medicinal cannabis product while 45% reported they believed it may be of some benefit to their medical condition. Of those who believed it beneficial, 71% indicated they thought it useful for pain relief. selleck indicated comfort discussing medicinal cannabis use with GPs and specialists (92% respectively); however, less than 10% had done this.

Just under half of patients surveyed believe that medicinal cannabis products may be helpful to their condition, and while the majority report willingness, few have discussed this with their GP or specialist. There is need for accessible, accurate information regarding the use of cannabis-based medicine for patients and doctors alike to guide the patient-doctor consultation and decrease barriers to open discussion.
Just under half of patients surveyed believe that medicinal cannabis products may be helpful to their condition, and while the majority report willingness, few have discussed this with their GP or specialist. #link# There is need for accessible, accurate information regarding the use of cannabis-based medicine for patients and doctors alike to guide the patient-doctor consultation and decrease barriers to open discussion.
Global trends show an increase in medication dispensing for attention-deficit/hyperactivity disorder (ADHD) in young people over time. The current study aimed to examine whether similar trends were observed in New Zealand youth over the period of 2007/08 to 2016/17.

We estimated the prevalence in ADHD medication dispensing using national pharmaceutical data for each fiscal year from 2007/08 to 2016/17 in approximately 2.4 million New Zealand youth aged 1-24 years. We also examined whether trends varied by sociodemographic factors.

The total dispensing prevalence almost doubled from 516 per 100,000 to 996 per 100,000 over the study period. Males had a consistently higher dispensing prevalence relative to females. Young people aged 7-17 years had the highest dispensing prevalence. The most deprived quintile had a slightly lower dispensing prevalence relative to other quintiles. Ethnic differences in dispensing prevalence were apparent, with deprivation differences also existing within most ethnic groups.

Overall, our study showed an increase in ADHD medication use by young people in New Zealand, similar to international findings.
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