'Survivorship care is one big gap': a qualitative study of post-treatment supportive care in Aotearoa New Zealand.

BACKGROUND: This study focuses on the provision of supportive care services and programmes for cancer survivors post-treatment in Aotearoa New Zealand (NZ). It aims to aid our understanding of an often challenging and fragmented phase of cancer survivorship, and lay the groundwork for future research into the development of survivorship care in NZ. METHODS: This study employed a qualitative design using semi-structured interviews with a range of healthcare providers (n = 47) involved in service provision for cancer survivors post active treatment, including supportive care providers; clinical and allied health providers; primary health providers; and Maori health providers. Data were analysed using thematic analysis. RESULTS: We found that cancer survivors in NZ face a range of psycho-social and physical issues post-treatment. The provision of supportive care to meet these needs is currently fragmented and inequitable. The key barriers to improved supportive care provision for cancer survivors post-treatment include a lack of capacity and resources within the existing cancer care framework; divergent attitudes to survivorship care within the cancer care workforce; and a lack of clarity around whose responsibility post-treatment survivorship care is. CONCLUSIONS: Post-treatment cancer survivorship should be established as a distinct phase of cancer care. Measures could include greater leadership in the survivorship space; the implementation of a survivorship model(s) of care; and the use of survivorship care plans; all of which could help improve referral pathways, and clarify clinical responsibility for post-treatment survivorship care.

Expert insights on digital contact tracing: interviews with contact tracing policy professionals in New Zealand.

Digital contact tracing (DCT) is the application of digital tools to assist with identifying and informing close contacts of a COVID-19 case. DCT is a potential solution to capacity constraints of current manual contact tracing processes. Expert opinion from contact tracing professionals rarely informs public discourse on the benefits and limitations of DCT solutions. Three focus groups were undertaken in New Zealand to understand benefits and limitations of DCT solutions from contact tracing professionals. One was with the National Investigation and Tracing Centre (NITC) and two were with Public Health Units (PHUs). Participants highlighted four key themes including: (i) equity, (ii) privacy, (iii) communication and public perception and (iv) the operational model. Participants were concerned DCT solutions could exacerbate existing health inequities due to lack of access to, or familiarity with, technology. Poor communication and public understanding of DCT were seen as a major threat to both the efficacy of DCT solutions and the wider COVID-19 response. Most importantly, end-users were cautious of the operational model for DCT data that might: (i) attempt to replace manual processes that cannot or should not be automated by technology (case investigations, follow-ups); (ii) place undue burden on citizens and (iii) increase the workload for the current system beyond its capacity, for unproven or limited benefit. To be effective, contact tracing professionals believed DCT technologies must have strong privacy safeguards, a clear and simple communication strategy, interoperability with the existing contact tracing system and a foundation of health equity.

What helps and hinders metformin adherence and persistence? A qualitative study exploring the views of people with type 2 diabetes.

AIM: To explore the views of people with type 2 diabetes who had initiated metformin monotherapy about what influences adherence and persistence. METHODS: We recruited participants through primary care, using purposive sampling, and undertook face-to-face, audio-recorded, semi-structured interviews with 10 Maori, 10 Pacific, and 10 non-Maori non-Pacific patients who had started metformin monotherapy for type 2 diabetes within the previous two years. A thematic analysis was undertaken using the Theory of Planned Behaviour as the overall theoretical framework. RESULTS: The perceived benefits of taking metformin included improving glycaemic control, preventing or slowing the progression of type 2 diabetes, and avoiding serious complications. Side effects (predominantly gastrointestinal) were the most commonly cited disadvantage. Participants employed a variety of strategies to help them take metformin regularly. Key reasons for initial sub-optimal adherence and persistence were side effects and not accepting the diagnosis of type 2 diabetes. Subsequently, omitting to take tablets was commonly unintentional (due to 'forgetfulness'). For many Pacific participants, changes in routine related to community and church events, or shift work, contributed to sub-optimal adherence. Some Maori participants would have preferred to use traditional medicines. CONCLUSION: We identified a number of factors within the scope of healthcare services that may assist healthcare providers to focus on, and address, some of the issues that appear to be of primary importance to people when they are prescribed metformin.

Drug safety awareness in New Zealand: public knowledge and preferred sources for information.

INTRODUCTION: To make informed choices about medical treatment options, patients and consumers need knowledge about the benefits and the risks of drugs. Little is known about levels of drug safety knowledge or preferred sources of drug safety information in general population samples. AIM: To explore drug safety knowledge, experience of adverse drug reactions (ADRs), and preferred sources for drug safety information in the New Zealand public. METHODS: We undertook a telephone survey of a random sample of adults (N=87) in the Dunedin area of New Zealand. RESULTS: Although 47% of those currently or recently using prescription or over-the-counter drugs (N=83) were unable to recall any safety information at all about the medicine they were taking, 84% felt confident they could use these medicines in a safe way. The experience of at least one ADR during the last five years was reported by 40%. The five most preferred sources for drug safety information among all participants were: doctor (92%), pharmacist (76%), information on/inside the medicine package (66%), nurse (57%), and the internet (41%). DISCUSSION: Our results add to findings from specific patient groups to show that there is a low level of drug safety knowledge in the general population. Primary health care practitioners have a recognised and vital part to play in promoting drug safety awareness.

Rise in psychotropic drug prescribing in children and adolescents during 1992-2001: a population-based study in the UK.

BACKGROUND: The trend towards increased psychotropic drug prescribing in children and adolescents is well recognised in North America and continental Europe. However, it is unclear to what extent these studies are applicable to clinical practice in the United Kingdom (UK). This study was conducted to estimate the prevalence of psychotropic drug prescribing in children and adolescents aged <19 years in general practice in the UK from January 1992 to December 2001. METHODS: Data were obtained from the General Practice Research Database (GPRD). Annual age- and sex-specific prevalence of psychotropic drug prescribing was calculated. RESULTS: A total of 143,079 prescriptions were issued to 34,398 study subjects. Stimulant prescriptions rose significantly from 0.03 per 1,000 (95% confidence interval 0.02-0.04) in 1992 to 2.9 per 1,000 (2.52-3.32) in 2001; a 96-fold increase. Methylphenidate accounted for the majority of stimulant prescriptions; 2.4% (349/14,370) of stimulant prescriptions were prescribed to children aged <6 years. Increased prescribing was also noted for antidepressants (1.6-fold), hypnotics/anxiolytics (1.3-fold), antipsychotics (1.3-fold) and anticonvulsants (1.3-fold), whilst the prevalence of clonidine and lithium prescribing remained fairly stable throughout the study period. The use of antidepressant, hypnotic/anxiolytic and anticonvulsant increased with increasing age. A high proportion of boys received stimulants, whereas antidepressants and hypnotics/anxiolytics were more likely prescribed to girls. CONCLUSION: There is an increased trend of psychotropic drug use in children and adolescents in the UK practice. Since most psychotropic drugs are not licensed for use in children at this time, research is needed to investigate the efficacy and long-term safety in this population.

Examination of the safety and use of apomorphine prescribed in general practice in England as a treatment for erectile dysfunction.

OBJECTIVE: To examine the safety and use of apomorphine as prescribed in general medical practice in England as a treatment for erectile dysfunction (ED). PATIENTS AND METHODS: Apomorphine hydrochloride (marketed as Uprima, Abbott Laboratories Ltd, UK) is licensed in the UK as a sublingual therapy for ED. It is the first treatment for ED with a central mode of action. This postmarketing observational cohort study was conducted using prescription-event monitoring (PEM) methods. Exposure information was obtained from dispensed prescription data for patients first prescribed apomorphine between October 2001 and December 2002. Outcome data were derived from Green-Form questionnaires posted to prescribing physicians > or = 6 months after the date of the first apomorphine prescription for each patient. The study cohort comprised 11 185 patients, 99.3% (11,111) of whom were men, with a median (interquartile range) age of 61 (54-68) years. RESULTS: The most frequently reported prescribing indication was ED and the most frequently reported reason for stopping apomorphine was that it was 'not effective'. In addition, the percentage of patients for whom apomorphine was reported to have been effective was relatively low. Headache was the most commonly reported adverse drug reaction, and the most frequently reported clinical condition occurring in the first month of observation. A small number of events (24) were reported that were not listed in the current Summary of Product Characteristics (SPC) and were considered by the prescribing general practitioner (GP) to be associated with apomorphine use. CONCLUSION: The proportion of patients for whom apomorphine was reported to be effective was low. Also, 'not effective' was the most frequently reported event and a high percentage of patients stopped apomorphine because it was 'not effective'. The most frequently reported clinical adverse events (headache and nausea) were those listed in the SPC. A small number of reports for unlabelled events were thought by prescribers to be related to apomorphine use. The confounding factors of patient age and coexisting disease should be considered when assessing data from this study.

Adrenalectomy-induced cell death in the dentate gyrus: further characterisation using TUNEL and effects of the Ginkgo biloba extract, EGb 761, and ginkgolide B.

This study investigated the potential neuroprotective effects of the Ginkgo biloba extract, EGb-761, and ginkgolide B, on adrenalectomy (ADX)-induced cell death in the dentate gyrus (DG). Adrenalectomised, sham surgery-treated, and naive controls received either EGb-761 (25, 50, or 100 mg/kg), 0.9% saline vehicle control, ginkgolide B (10 or 25 mg/kg), or a polyethylene glycol vehicle control, i.p, daily for 6 days postsurgery. Cell death in the DG was determined by in situ labelling of DNA fragments, using the TUNEL method; sections were counterstained with hematoxylin. Radioimmunoassay was used to confirm a decrease in plasma corticosterone (CORT) after ADX. TUNEL-positive granule cells were observed in the DG at 1 week, but not at 24 h, post-ADX. The rate of granule cell death at this time was highest in the suprapyramidal blade and increased in a crest tip and a rostrotemporal gradient. Whereas CORT replacement completely prevented the occurrence of TUNEL-positive granule cells, EGb-761 and ginkgolide B did not, at any of the doses used. These results suggest that these drugs may not have substantial neuroprotective effects in the ADX model of neurodegeneration.

The CNS effects of Ginkgo biloba extracts and ginkgolide B.

Ginkgo biloba extracts such as EGb-761 have been suggested to have a multitude of beneficial effects on CNS function, from enhancing cognitive function in dementia to facilitating recovery from acute forms of neural damage such as hypoxia/ischemia. Ginkgolide B, one of the major components of EGb-761, is a potent platelet-activating factor (PAF) receptor antagonist, which is also regarded as having neuroprotective effects in the CNS. The aim of this review is to summarise and to critically evaluate the current evidence on the CNS effects of EGb-761 and ginkgolide B, with particular emphasis on the data relating to their neuroprotective effects.