Joyce Guo

Tēnā koutou katoa and welcome to Issue 36 of Te Hautaka o ngā Akongā Rongoā, the New Zealand Medical Student Journal (NZMSJ). The theme of this issue is “Advocacy in Health,” which is crucial in the betterment of the healthcare system for both patients and health professionals. It is our privilege to share with our readers a wide range of insightful and high-quality articles by health care professional students, clinicians, and academics from Aotearoa. Advocacy plays a core role in the realm of healthcare, serving as a powerful catalyst for positive change and improved outcomes on both individual and systemic levels. Healthcare advocacy for the individual involves standing up for the rights, needs, and well-being of patients, ensuring that their voices are heard and their concerns addressed. On a broader scale, advocacy in healthcare contributes to the refinement of healthcare policies, regulations, and services. As providers working on the front lines, health professionals often better identify areas of necessary improvement than policy-makers. Advocacy campaigns and initiatives can shed light on systemic issues, drive policy changes, and influence healthcare regulations that ultimately shape the healthcare experience for everyone. We believe that by holding stakeholders accountable and pushing for transparency, advocacy serves as a counterbalance to potential shortcomings in the healthcare sector. Overall, the significance of ad- vocacy in healthcare extends beyond individual cases, contributing to a more inclusive, patient-centric, and effective healthcare system for entire communities and populations.

Background: Supracondylar humeral fractures (SCHF) are a common cause of orthopedic morbidity in pediatric populations across the world. The treatment of this fracture is likely one of the first procedures involving x-ray–guided wire insertion that trainee orthopedic surgeons will encounter in their career. Traditional surgical training methods of “see one, do one, teach one” are reliant on the presence of real-world cases and must be conducted within an operative environment. We have developed an augmented reality simulator that allows trainees to practice this procedure in a radiation-free environment at no extra risk to patients. Objective: This study aims to examine whether training on a simulator in addition to traditional surgical training improves the in-theater performance of trainees. Methods: This multicenter, interventional cohort study will involve orthopedic trainees from New Zealand in their first year of advanced training between 2019 and 2023. Advanced trainees with no simulator exposure who were in their first year in 2019-2021 will form the comparator cohort, while those in the years 2022-2023 will receive additional regular simulator training as the intervention cohort. The comparator cohort’s performance in pediatric SCHF surgery will be retrospectively audited using routinely collected operative outcomes and parameters over a 6-month period. Data on the performance of the intervention cohorts will be collected in the same way over a comparable period. The data collected for both groups will be used to determine whether additional training with an augmented reality training shows improved real-world surgical outcomes compared to traditional surgical training. Results: As of February 2022, a total of 8 retrospective comparator trainees have been recruited by email. The study is financially supported through an external grant from the Wishbone Orthopaedic Research Foundation of New Zealand (September 2021) and an internal research grant from the University of Otago (July 2021). Conclusions: This protocol has been approved by the University of Otago Health Ethics committee (reference HD21/087), and the study is due for completion in 2024. This protocol may assist other researchers conducting similar studies in the field. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12623000816651; https://tinyurl.com/mtdkecwb International Registered Report Identifier (IRRID): DERR1-10.2196/38282

BACKGROUND Supracondylar humeral fractures (SCHF) are a common cause of orthopedic morbidity in pediatric populations across the world. The treatment of this fracture is likely one of the first procedures involving x-ray–guided wire insertion that trainee orthopedic surgeons will encounter in their career. Traditional surgical training methods of “see one, do one, teach one” are reliant on the presence of real-world cases and must be conducted within an operative environment. We have developed an augmented reality simulator that allows trainees to practice this procedure in a radiation-free environment at no extra risk to patients. OBJECTIVE This study aims to examine whether training on a simulator in addition to traditional surgical training improves the in-theater performance of trainees. METHODS This multicenter, interventional cohort study will involve orthopedic trainees from New Zealand in their first year of advanced training between 2019 and 2023. Advanced trainees with no simulator exposure who were in their first year in 2019-2021 will form the comparator cohort, while those in the years 2022-2023 will receive additional regular simulator training as the intervention cohort. The comparator cohort’s performance in pediatric SCHF surgery will be retrospectively audited using routinely collected operative outcomes and parameters over a 6-month period. Data on the performance of the intervention cohorts will be collected in the same way over a comparable period. The data collected for both groups will be used to determine whether additional training with an augmented reality training shows improved real-world surgical outcomes compared to traditional surgical training. RESULTS As of February 2022, a total of 8 retrospective comparator trainees have been recruited by email. The study is financially supported through an external grant from the Wishbone Orthopaedic Research Foundation of New Zealand (September 2021) and an internal research grant from the University of Otago (July 2021). CONCLUSIONS This protocol has been approved by the University of Otago Health Ethics committee (reference HD21/087), and the study is due for completion in 2024. This protocol may assist other researchers conducting similar studies in the field. CLINICALTRIAL Australian New Zealand Clinical Trials Registry ACTRN12623000816651; https://tinyurl.com/mtdkecwb INTERNATIONAL REGISTERED REPORT DERR1-10.2196/38282

Objectives The aims of this study were to describe the following: (1) the time to change of therapy in patients with type 2 diabetes who had initiated metformin monotherapy as first-line treatment and (2) the sequence in which subsequent therapeutic regimens were introduced. Design Cohort study. Setting National study based on linked data from the New Zealand Ministry of Health’s National Collections of health and pharmaceutical dispensing data. Participants People with type 2 diabetes mellitus who initiated metformin monotherapy between 1 January 2006 and 30 September 2014 (n=93 874). Primary outcome measures Cumulative incidence curves were plotted to show the time taken to move from one regimen to another, while sunburst plots were used to illustrate the sequence in which regimens were introduced. Results About 10% and 35% of cohort members had moved to a second regimen 1 year and 5 years, respectively, after initiating metformin monotherapy; the majority received a regimen recommended by New Zealand treatment guidelines (mostly metformin and a sulphonylurea). Of those who started a recommended second regimen, 37% and 67% had moved to a third regimen after 1 and 5 years, respectively; the corresponding proportions for those who started an ‘other’ (not listed as recommended) second regimen were 53% and 75%. Most of those who received a third regimen after a recommended second regimen were dispensed an ‘other’ third regimen. Of those who moved to a third regimen from an ‘other’ second regimen, similar proportions received recommended and ‘other’ third regimens. Conclusions Real-world type 2 diabetes treatment patterns in New Zealand are complex and not always consistent with guidelines.