The New Zealand medical journal
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Review
PHARMAC funding of 9-week concurrent trastuzumab (Herceptin) for HER2-positive early breast cancer.
A 9-week regimen of trastuzumab (Herceptin) given concurrently with a taxane will be funded for HER2-positive early breast cancer patients in New Zealand. The use of trastuzumab in this population has been investigated in sequential (after chemotherapy) or concurrent (with taxane chemotherapy) settings. Five RCTs have been reported--HERA, NSABP B31, NCCTG N9831, BCIRG 006, and FinHer. ⋯ New data--from the sequential treatment arm of trial N9831, showing benefits that were small and statistically non-significant, and the HERA 23-month follow-up, suggesting a waning in efficacy with time--have since cast further doubt on the extent and durability of the sequential 12-month regimen's efficacy. DHBs and PHARMAC remain open to funding longer duration regimens if cost effectiveness improves significantly and budget/resource implications become acceptable. PHARMAC has committed to international efforts (the SOLD trial) to resolve questions of optimal treatment duration.
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We report the influenza activity in New Zealand in 2005 (including an influenza B epidemic) in terms of the disease burden, hospitalisations, viral strain characterisations, and vaccine recommendations. ⋯ The influenza surveillance in 2005 recorded the highest influenza B activity over the last 15 years with co-circulation of influenza B (Hong Kong) and B (Shanghai) strains in an epidemic. The peak of influenza B activity preceded the peak of influenza A activity with significant antigenic drift among the A/Wellington/1/2004 (H3N2)-like viruses and B/HongKong/330/2001-like viruses. Significant excess morbidity was observed in the 5 to 19 year age group in a highly variable geographical distribution across New Zealand. This confirms the value of the national influenza surveillance system as an essential public health component for monitoring the incidence and distribution of influenza and predominant strains in New Zealand.
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We present the first ever report of streptobacillary rat-bite fever in New Zealand. The patient was a young man who was admitted with systemic sepsis. ⋯ Blood cultures grew Streptobacillus moniliformis, thus confirming the diagnosis. The literature on rat-bite fever is also reviewed.
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Adrenaline is vital in the treatment of severe allergic reactions (anaphylaxis), however it is often underutilised or inappropriately administered. Adrenaline treatment is not without risk and most adverse reactions to adrenaline occur when it is given in overdose or as an intravenous bolus. We report a case of myocardial injury and hypotension following inappropriate administration of adrenaline.
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To describe current screening and intervention practice for alcohol problems in a New Zealand trauma centre. ⋯ Formal screening and interventions for alcohol problems among this group of inpatients were infrequent, indicating missed opportunities to reduce alcohol-related harm and, potentially, trauma recurrence. Effective approaches for alcohol screening and intervention in the New Zealand trauma inpatient setting require review.