Case commentary: a 'merciful approach' to discipline for a New Zealand lawyer's misconduct.

A recent decision reveals how a New Zealand's disciplinary tribunal promoted justice for an unwell lawyer in a case of professional misconduct. In 2023, the Lawyers and Conveyancers Disciplinary Tribunal (LCDT) applied a 'merciful approach' when assessing the lawyer's misconduct and health issues. In Auckland Standards Committee 3 v Ms W [2023], the LCDT discussed the impacts of reproductive treatment in relation to the practitioner's conduct. This decision is the foundation to compare the disciplinary regime for legal and health practitioners in New Zealand. The article outlines New Zealand's framework for discipline of lawyers, noting the absence of a health pathway. The article discusses opportunities to resolve cases involving impaired lawyers outside the disciplinary system, including benefits and disadvantages of mandatory reporting. While focusing on the legal profession, the discussion is relevant to other professions and examines health-promoting regulatory strategies from other jurisdictions.

Fear avoidance and return to work after mild traumatic brain injury.

OBJECTIVES: Fear avoidance is associated with symptom persistence after mild traumatic brain injury (mTBI). In this study, we investigated whether fear avoidance was associated with other outcomes such as return to work-related activity (RTW). MATERIALS AND METHODS: We analyzed associations between fear avoidance and RTW 6-9 months after mTBI, in two merged prospective mTBI cohorts. Adult participants aged 16 or over (n=175), presenting to outpatient services in New Zealand within 3 months of their injury, who were engaged in work-related activity at the time of injury, were included. Participants completed the Fear Avoidance Behavior after Traumatic Brain Injury (FAB-TBI) questionnaire at enrollment and 6 months later. Associations between FAB-TBI scores and RTW outcome were analyzed using multivariate approaches. RESULTS: Overall, 53% of participants had RTW by 6-9 months after mTBI. While early fear avoidance was weakly associated with RTW, persistent high fear avoidance between study assessments or increasing avoidance with time were associated with greater odds of still being off work 6-9 months after injury. CONCLUSIONS: Pervasive and increasing avoidance of symptom triggers after mTBI were associated with lower rates of RTW 6-9 months after mTBI. Further research is needed to better understand transition points along the recovery trajectory where fear avoidance behaviors fade or increase after mTBI.

Criminal Convictions of Disciplined Health Practitioners in New Zealand.

This study investigates the rates and types of criminal convictions encountered by New Zealand's Health Practitioners Disciplinary Tribunal (HPDT) over a 15-year period. Criminal convictions appeared in 24% (n = 101) of cases, with male practitioners (p < 0.01) and pharmacists (p < 0.05) being significantly over-represented. The most frequent types of convictions included crimes against rights of property (33.6%), sexual/morality/decency crimes (21.9%) and misuse of drugs (8.4%). Criminal behaviour settings were evenly split between personal and professional life for medical practitioners (56.5% professional life) and nurses (56.5% professional life) but disproportionately in professional life (85%) for pharmacists. Criminal conviction cases were significantly more likely to result in registration cancellation (p < 0.001) and practice suspensions (p < 0.05) when compared with non-criminal cases, although fewer fines were ordered (p < 0.001). Profession-specific risk factors, alongside how to rehabilitate members of the subgroup who may later seek to renew their practice are areas for further research, are discussed.

Psychosocial and financial impacts for carers of those with eating disorders in New Zealand.

BACKGROUND: Eating disorders (ED) can have profound effects on family members and carers. These impacts can be experienced across multiple domains and may contribute to the maintenance of ED symptoms. In the absence of any New Zealand studies quantifying this, and given country-specific differences in access to care and treatment, this study explores the psychosocial and economic impacts on those caring for someone with an ED in New Zealand. METHODS: Carers (N = 121) of those who had, or still had, a self-reported ED (82.6% anorexia nervosa) completed an online survey open between December 2016 and October 2020, adapted to the New Zealand context. Questions addressed ED recency and recovery status of the individual cared for, treatment access, and the financial and psychosocial impact on the carer. Data analysis included descriptive statistics, with financial cost data converted to the equivalent of 2020 New Zealand dollars. RESULTS: Most (88.6%) recruited carers reported still caring for someone with ED symptoms of varying severity. A majority reported difficulty accessing treatment for the person they cared for, with a sizable minority (45%) paying for private treatment, despite few having private insurance. Carer losses typically included reduced income and productivity, travel costs, and other miscellaneous costs. Carers reported significant psychosocial impacts across a range of dimensions including family life, interpersonal relationships, and their own personal well-being. CONCLUSIONS: Carers in New Zealand report impacts which are far reaching and longstanding, covering their own personal and interpersonal well-being and that of those around them. While most of those they care for get access to public (free) treatment at some time or another, the wider financial and economic impacts on carers are significant, and likely to take years to recoup. Though not unique to EDs, interventions and supports for carers are much needed in New Zealand, alongside more comprehensive research methodology to further determine positive and other impacts of EDs over the long course of the caregiving role. HIGHLIGHTS: A majority reported difficulty accessing treatment for the person they cared for 45% paid for private treatment, despite few having private insurance Carers reported reduced income and productivity, travel costs, and other costs. Carers reported significant psychosocial impacts on family life, interpersonal relationships, and their own personal well-being. Carers provide a pivotal role in supporting treatment and recovery in their family member with the These findings will be relevant for funders and service providers in developing further approaches to address barriers and gaps in service provision to reduce impacts on carers, and as a result, those with eating disorders.

Caring for a person with any significant health or disability condition can have a harmful effect on the carer's own wellbeing. This study estimates this burden of caring for people with either ongoing ED symptoms or who have recovered, in New Zealand. The study recruited 121 carers, of whom almost all (97.5%) were parents, with most caregivers reporting impacts as this related to caring for someone with anorexia nervosa (82.6%).Overall, the results found widespread impacts on carers, particularly impacts on multiple relationships in their life, especially family relationships. These impacts extended to reporting harmful effects on the relationship with the person with the ED. Carers are also burdened by difficulties accessing treatment and wider economic impacts such as loss of income and productivity at work. As New Zealand's health system is relatively unique and this is the first quantitative study in New Zealand exploring ED carer impacts, larger studies are needed to capture the full extent of this in order to better meet these needs both at a health service and government level.

Breaches of New Zealand's Health and Disability Services Consumers' Rights: Human Rights Review Tribunal Decisions.

This article illuminates New Zealand's legal response to breaches of rights within the health and disability services context. Alleged breaches of the Code of Health and Disability Services Consumers' Rights may be heard by the Human Rights Review Tribunal. The article describes this body's composition and powers, as well as patterns within the 44 relevant decisions published between 1 January 2002 and 30 June 2019. New Zealand's unique medico-legal system created a distinctive legal response to breaches of the rights of "consumers". The Tribunal decisions in this article relate to breaches of consumers' rights by both registered and unregistered providers. The research contributes to international scholarship regarding how justice is administered when consumers' rights are breached. Also, it contributes to international debates devoted to public protection and complaints resolution, through constructive critique.

Fifteen Years On: What Patterns Continue to Emerge from New Zealand's Health Practitioners Disciplinary Tribunal?

Disciplinary tribunals are deserving of review, in the interests of fairness, transparency and educational value for key stakeholders. New Zealand's Health Practitioners Disciplinary Tribunal (HPDT) determines whether registered health practitioners have engaged in misconduct that warrants discipline. The current study considers patterns regarding HPDT hearing processes and outcomes (2004-2020) (420 decisions), expanding knowledge from a previous analysis of HPDT decisions (2004-2014). The findings suggest that the HPDT has largely upheld its goal of consistency. However, shifts over time have included a reduced rate of appeals, and changing patterns for both the grounds for discipline and penalties applied. Differences in HPDT processes and penalties between medical practitioners, nurses and pharmacists were largely accounted for by the factors of practitioner attendance and legal representation at the hearing. This study contributes to understanding who transgresses, how they transgress and the penalties imposed. Such insights may be applied preventively for the benefit of all stakeholders.

Wrestling with uncertainty after mild traumatic brain injury: a mixed methods study.

Purpose: Our objective was to explore the intersection between mild traumatic brain injury (MTBI) recovery experiences and injury understandings, using both quantitative and qualitative methods.Materials and Methods: The quantitative component was a descriptive case-control study comparing participants (n = 76) who had recovered or not recovered after an MTBI, across demographic and psychological variables. A subset of participants (n = 10) participated in a semi-structured interview to explore experiences of recovery in more detail. We followed threads across the datasets to integrate findings from component methods.Results: The quantitative analyses revealed differences between the two groups in terms of injury recovery understandings and expectations. The qualitative analyses suggested that achieving consistency across information sources was important. By tracing threads back and forth between the component datasets, we identified a super-ordinate meta-theme that captured participants' experiences of wrestling with uncertainty about their recovery and the impacts in terms of heightened anxiety, confusion, and feelings of invalidation.Conclusion: The effectiveness of psychoeducation and reassurance after MTBI may be optimized when content is tailored to the individual. Clinicians are urged to attend both to the subjective interpretations patients make of information gained from formal and informal, internal and external sources, and where information across these sources conflicts and creates uncertainty.Implications for rehabilitationEffectiveness of psychoeducation and reassurance after injury may be optimized when content is tailored to the individual rather than being generic.Effectiveness of such interventions may also be optimized by understanding the subjective interpretations individuals make of injury knowledge gleaned from formal and informal, internal and external sources.Conflicting information from such multiple sources may create uncertainty with associated increased distress as an individual negotiates their recovery from injury. Attending to this uncertainty may be a helpful target for treatment.

Psychometric Characteristics of the Revised Illness Perception Questionnaire (IPQ-R) in People Undergoing Weight Loss Surgery.

The Illness Perception Questionnaire-Revised (IPQ-R) has been used extensively across many health conditions to measure patient illness and treatment perceptions. The constructs have an association with treatment adaptation and adherence which, in turn, are considered core factors involved in bariatric surgery outcome. This study examines the factorial validity and internal reliability of a modified (IPQ-R) in bariatric surgery candidates. After wording modifications, participants (N = 310) completed the IPQ-R as part of standard pre-surgery assessments. After removal of two items, confirmatory factor analysis (CFA) supported the original 7-factor solution of the Beliefs scale, with good to marginal subscale internal consistency. Exploratory factor analysis (EFA), with two items removed only partially supported the original 5-factor Causal Attributions scale. Internal consistency was unacceptably low for two subscales. Further research is needed to generate new items which better fit the IPQ-R to this population before research can explore the relevance of illness perceptions.

Evaluating the effectiveness of therapeutic horse riding for children and young people experiencing disability: a single-case experimental design study.

Purpose: Therapeutic horse riding aims to improve the health of children and young people experiencing disability; however, its benefits across a range of health domains, particularly the impact on participation outcomes, are not well known. This research evaluated to what extent there was a change in riders balance, functional performance, social responsiveness, quality of life and participation outcomes as a result of therapeutic horse riding.Methods: A multiple-baseline across participants (n = 12) single-case experimental design, with randomly allocated baseline phase lengths, quantitatively evaluated how riders responded to a 20-week intervention.Results: Social participation outcomes measured using the Canadian Occupational Performance Measure demonstrated the most consistent positive between-phase differences (performance ES = 1.20, 95% CI [0.82, 1.63]; satisfaction ES = 1.11, 95% CI [0.73, 1.55]). A causal relationship was seen in three riders, but improvements only reached clinical significance for two riders when accounting for phase data trends. No significant outcome patterns were found comparing riders with principally physical impairments to those with principally psychosocial impairments.Conclusions: Being involved in therapeutic horse riding may improve rider's social participation in home, school and community settings. We postulate that rider self-concept development may be a mechanism of treatment effect leading to participation-level changes.Implications for rehabilitationSocial participation was the health outcome demonstrating the most consistent change following therapeutic horse riding, regardless of rider impairment.Therapeutic horse riding can improve social participation in settings beyond the riding arena.Greater intervention tailoring based on rider responses may enhance therapeutic horse riding intervention effects.

Commentary on disordered eating symptoms and bariatric/metabolic surgery.

OBJECTIVE: This article presents an argument for the rethinking of concerns around bariatric/metabolic surgery in people with disordered eating. CONCLUSION: Practice has usually been cautious but disordered eating and eating disorders should not be a contraindication other than exceptional cases. Further research directions are suggested.

Consensual Sexual Relationships between Health Practitioners and Their Patients: An Analysis of Disciplinary Cases from New Zealand.

Consensual sexual relationship between health practitioners and their patient are considered one of the most serious breaches of professional boundaries. Prevalence rates are difficult to establish since underreporting may occur, yet media attention may conflate the perception of prevalence. In this study we first reviewed the literature for risk factors for health practitioners and patients, professional standards, and responses of disciplinary bodies. Following this, we quantitatively summarised case characteristics and disciplinary outcomes from a 14-year cohort of New Zealand's Health Practitioners Disciplinary Tribunal proceedings. From the 26 cases identified, four themes were discussed in detail and illustrated with cases. These include: female practitioners working in correctional settings; zero tolerance but no registration repercussions; patient vulnerabilities when help-seeking for mental health issues; and the use of rehabilitative penalties. Despite the difficulties in conducting research on sexual boundary violations, this raises awareness, encourages proactive reporting, and inspires constructive strategies.

Outcomes of Notifications against Psychologists in the New Zealand Health Regulation Context 2004-2015.

Research focusing on disciplined health practitioners is growing though exploring lower level decisions is also important. This study examines the outcomes and characteristics of psychologists subject to formal notifications between 2004 and 2015. Data were extracted from archived notification files (N = 396) held by the New Zealand Psychologists Board alongside publically available decisions of the Health Practitioners Disciplinary Tribunal (N = 13). Annually, <2% of practising psychologists were subject of a notification. Outcomes varied by type of notification but the vast majority resulted in no further action either at initial triage or after further investigation. Notifications involving psychologist scope practitioners and those with overseas qualifications prior to New Zealand registration were significantly more likely to result in further investigation. All 13 prosecutions resulted in a finding of guilt. Further research is needed to explore risk factors and why female practitioners may be over-represented in cases of sexual boundary transgressions.

Untangling chronic pain and post-concussion symptoms: the significance of depression.

OBJECTIVES: Post-concussion-like symptoms (PCS) are common in patients without a history of brain injury, such as those with chronic pain (CP). This exploratory study examined neuro-cognitive and psychological functioning in patients with PCS following mild traumatic brain injury (mTBI) or CP, to assess unique and overlapping phenomenology. METHODS: In this case-control study, participants (n = 102) with chronic symptoms after mTBI (n = 45) were matched with mTBI recovered (n = 31) and CP groups (n = 26), on age, gender, ethnicity and education. Psychological status, cognitive functioning, health symptoms, beliefs and behaviours were examined. RESULTS: Participants who had not recovered from an mTBI and participants with CP did not differ in terms of PCS symptoms, quality of life, distress or illness behaviours, however, the CP group endorsed fewer subjective cognitive problems, more negative expectations about recovery and more distress (p < 0.05). On cognitive testing participants who had not recovered from an mTBI demonstrated greater difficulties with attention (p < 0.01) although differences disappeared when depression was controlled in the analyses. CONCLUSIONS: Unique patterns associated with each condition were evident though caution is required in attributing PCS and cognitive symptoms to a brain injury in people with mTBI presenting with chronic pain and/or depression. Psychological constructs such as illness and recovery beliefs appear to be important to consider in the development of treatment interventions.

Examining a staging model for anorexia nervosa: empirical exploration of a four stage model of severity.

BACKGROUND: An illness staging model for anorexia nervosa (AN) has received increasing attention, but assessing the merits of this concept is dependent on empirically examining a model in clinical samples. Building on preliminary findings regarding the reliability and validity of the Clinician Administered Staging Instrument for Anorexia Nervosa (CASIAN), the current study explores operationalising CASIAN severity scores into stages and assesses their relationship with other clinical features. METHOD: In women with DSM-IV-R AN and sub-threshold AN (all met AN criteria using DSM 5), receiver operating curve (ROC) analysis (n = 67) assessed the relationship between the sensitivity and specificity of each stage of the CASIAN. Thereafter chi-square and post-hoc adjusted residual analysis provided a preliminary assessment of the validity of the stages comparing the relationship between stage and treatment intensity and AN sub-types, and explored movement between stages after six months (Time 3) in a larger cohort (n = 171). RESULTS: The CASIAN significantly distinguished between milder stages of illness (Stage 1 and 2) versus more severe stages of illness (Stages 3 and 4), and approached statistical significance in distinguishing each of the four stages from one other. CASIAN Stages were significantly associated with treatment modality and primary diagnosis, and CASIAN Stage at Time 1 was significantly associated with Stage at 6 month follow-up. CONCLUSIONS: Provisional support is provided for a staging model in AN. Larger studies with longer follow-up of cases are now needed to replicate and extend these findings and evaluate the overall utility of staging as well as optimal staging models.

The Role of Regular Eating and Self-Monitoring in the Treatment of Bulimia Nervosa: A Pilot Study of an Online Guided Self-Help CBT Program.

Background: Despite cognitive behavioural therapy (CBT) being regarded as the first-line treatment option for bulimia nervosa (BN), barriers such as its time-consuming and expensive nature limit patient access. In order to broaden treatment availability and affordability, the efficacy and convenience of CBT could be improved through the use of online treatments and selective emphasis on its most 'potent' components of which behavioural techniques form the focus. Method: Twenty-six individuals with BN were enrolled in an online CBT-based self-help programme and 17 completed four weeks of regular eating and food-monitoring using the online Food Diary tool. Participants were contacted for a weekly check-in phone call and had their bulimic symptom severity assessed at five time points (baseline and weeks 1-4). Results: There was a significant decrease in the frequency of self-reported objective binge episodes, associated loss of control and objective binge days reported between pre- and post-treatment measures. Significant improvements were also observed in most subscales of the Eating Disorder Examination-Questionnaire. Conclusion: This study provides encouraging preliminary evidence of the potential of behavioural techniques of online CBT in the treatment of BN. Online therapy with this focus is potentially a viable and practical form of treatment delivery in this illness group. These preliminary findings support the need for larger studies using control groups.

Practitioner Health Issues Featuring Before New Zealand's Health Practitioners Disciplinary Tribunal: An Analysis of Cases 2003-2014.

Increasingly, the health and wellbeing of professionals is causing concern, particularly when it compromises the interests of those they serve. Often their health issues are reported when their conduct results in professional disciplinary action. In New Zealand, health practitioners who appeared before the Health Practitioners Disciplinary Tribunal for misconduct reported a range of physical and mental health conditions. This study of 288 decisions revealed the professions that reported diverse health issues, including categories of health issues, in published decisions between 2004 and 2014. The study also identified how frequently practitioners self-reported impairment or submitted health evidence from others of their physical and/or mental health status and/or their substance dependence. The study's findings may be applied preventatively for the benefit of practitioners and the people they serve, thereby promoting the Health Practitioners Competence Assurance Act 2003 (NZ)'s emphasis on public safety.

What's wrong with me? seeking a coherent understanding of recovery after mild traumatic brain injury.

PURPOSE: Qualitative research examining experiences of recovering from mild traumatic brain injury (MTBI) is limited. Findings from quantitative studies regarding predictors of persisting symptoms are inconsistent with limited attention directed to capturing broad perspectives and priorities of the wider stakeholders. More flexible research approaches may help advance the field. We used a mixed method design to generate patient perspectives of MTBI recovery, integrating these with quantitative investigation to isolate factors that might contribute to divergent MTBI outcomes. METHODS: The qualitative component reported here involved semi-structured interviews with selected participants (n = 10) from the quantitative study cohort, sampling both recovered and non-recovered adult MTBI participants. Interviews focused on participants' general description and understandings of their recovery and perceptions of what helped or hindered this. Data were analyzed using general thematic analysis. RESULTS AND CONCLUSION: Participants regardless of recovery status identified the importance of having a coherent understanding of their injury and recovery. Factors facilitating coherence included social support, validation, reassurance, accessing credible evidence-based information and having a pathway to wellness. Findings suggested that coherence could be a helpful umbrella construct worthy of examination in future MTBI research. This construct appears broad and able to cope with the complexity of individual experiences after injury. Implications for rehabilitation Sense of coherence may be a helpful umbrella construct that can facilitate resilience and positive recovery beliefs and expectations after mild traumatic brain injury. Reassurance, validation, and social support appear important and may facilitate injury recovery. Focus on the experiences of people recovering from mild traumatic brain injury may help to refine recovery models and understandings and thus provide more effective intervention targets.

Evaluating quality of life outcomes following joint replacement: psychometric evaluation of a short form of the WHOQOL-Bref.

PURPOSE: Reducing participant burden is important in health research and clinical assessment. We examined the psychometric properties of the EUROHIS-QOL 8-item index, a short version of the 26-item World Health Organisation Quality of Life questionnaire (WHOQOL-Bref), in a sample of people receiving joint replacement surgery. METHODS: Participants (n = 1008) completed the WHOQOL-Bref at either 6, 12, 24 or 60 months after hip or knee replacement. The factor structure, differential item functioning (DIF) and unidimensionality of the EUROHIS-QOL 8-item index were examined using exploratory and confirmatory factor analyses and Rasch analyses. Convergent validity was examined using correlations with the parent measure and other patient-reported outcome measures (Oxford scores, Western Ontario and McMaster Universities Osteoarthritis Index). Discriminant validity was assessed between groups reporting high versus low pain and function, and by joint replaced. RESULTS: The measure demonstrated high internal consistency (α = 0.86), adequate convergent (r = 0.47-0.82, p < 0.001) and discriminant validity (p < 0.001). Factor and Rasch analyses supported a unidimensional structure. However, there were also indications of multidimensionality, with support for a two-factor model focusing on general health and function, and psychosocial aspects of QOL. There was minimal evidence of DIF, with just one item evaluating energy level showing DIF for age. CONCLUSIONS: The EUROHIS-QOL 8-item index demonstrated adequate properties as a unidimensional scale and as a two-factor scale evaluating general health and function, and psychosocial aspects of quality of life. It is low on clinical and participant burden, showed minimal ceiling effects and showed good concurrent and discriminant validity.

Name Suppression Practices of New Zealand's Health Practitioners Disciplinary Tribunal 2004-2014.

Permanent name suppression decisions related to health practitioner disciplinary proceedings can result in debate across various interest groups, including practitioners, the public, the media and complainants themselves. However, there has been no analysis of name suppression patterns, principles and practices in New Zealand since the 2004 legislative reforms under the Health Practitioners Competence Assurance Act 2003 (NZ) provided for the combined regulation of 21 health professions and established the Health Practitioners Disciplinary Tribunal (HPDT) to hear and determine charges relating to those professions. This article reviews health practitioner name suppression debates within New Zealand in light of an exploratory descriptive analysis that was undertaken of 288 published decisions of the HPDT from 2004 to 2014. The study revealed that just under one-half of all cases involved a permanent name suppression application; amongst these, just over one-third were approved. Grounds cited for approving or declining name suppression varied and generally reflected established case law regarding naming principles and the Act's intent. While the public interest dominated as the most frequently cited reason to decline name suppression, the most frequent justification for granting name suppression was the health and wellbeing of various individuals. The findings have relevance for understanding current trends in name suppression, and whether there are changing practices or differences adopted between health practitioner groups.