aim: The aim of this study was to assess clinical outcomes, including breathlessness, after diaphragm plication in patients with symptomatic diaphragm paralysis. methods: A retrospective cohort study of all patients undergoing diaphragm plication at Christchurch Hospital between 1 January 2018 and 31 December 2022 was conducted. Breathlessness was assessed using the Medical Research Council (MRC) dyspnoea scale, derived from clinic letters pre-operatively and at routine post-operative follow-up. Pre- and post-operative MRC scores were compared using paired non-parametric testing. Secondary outcomes included post-operative complications, 30-day readmission and 30- and 90-day mortality. results: There were 37 patients identified who underwent diaphragm plication during the study period. Paired pre- and postoperative MRC scores were available for 32 patients. Median pre-operative MRC score was three (interquartile range [IQR] 3–4), improving to two (IQR 1–2) post-operatively, representing a median improvement of two MRC grades (p<0.001). Breathlessness improved in 31/32 patients (97%), was unchanged in 1/32 (3%) and worsened in none. Post-operative pneumonia occurred in three out of 37 patients (8%), and eight of 37 patients (22%) were readmitted within 30 days. There was no mortality at 30 or 90 days. conclusion: Diaphragm plication was associated with substantial improvement in patient-reported breathlessness and acceptable short-term morbidity in selected symptomatic patients.
aim: The aim of this study was to quantify the current state of the cardiac sonographer workforce within Health New Zealand – Te Whatu Ora. methods: In 2024, the Cardiac Society of Australia and New Zealand surveyed all Health New Zealand – Te Whatu Ora echocardiography departments to collect workforce data on cardiac sonographers. Population data were obtained from Health New Zealand – Te Whatu Ora. results: A total of 109 Health New Zealand – Te Whatu Ora–employed cardiac sonographers were identified. Of these, 72 (70%) were female and 71 (70%) trained in New Zealand. Twenty percent were aged over 50 years, with experience ranging from trainees to 45 years in practice. Nationally, there was one cardiac sonographer per 49,000 people, compared with one per 14,000 in Australia. In two of the five districts with the highest proportions of Māori and Pacific people, this ratio exceeded the national average: Northland (1:69,000) and Hawke’s Bay (1:62,000). Workforce capacity remained largely unchanged over time, from 1.4 full-time equivalent (FTE) per 100,000 population in 2010 to 1.6 FTE per 100,000 in 2024, while vacancies increased from 3.2 FTE (4.5%) in 2013 to 15.9 FTE (19%) in 2024. conclusions: New Zealand has substantially fewer cardiac sonographers than Australia, with little growth in workforce capacity and a fivefold increase in vacancies since 2013, raising concerns about workforce sustainability and equitable access to echocardiography services.
aim: The aim of this viewpoint was to examine how deficit discourse shapes health research and clinical practice in Aotearoa New Zealand and to argue that strengths-based framing and Kaupapa Māori methodologies should become standard expectations for researchers, clinicians, institutions and journals. method: A viewpoint was developed from the creation of an online module on strengths-based language for a Māori Health Advancement research curriculum, drawing on Kaupapa Māori scholarship and national and international evidence on the effects of deficit framing. results: Deficit framing remains routine in research, clinical documentation and quality improvement activity in Aotearoa. It obscures the structural determinants of inequity, transmits stigma between clinicians and reduces engagement with health services. Strengthsbased frames and Kaupapa Māori methodologies provide practical, evidence-informed alternatives, and specific responsibilities can be identified at each level of the research and health system. conclusion: The language of health research is an equity issue. Researchers, clinicians, institutions and journals in Aotearoa each hold distinct responsibilities to replace deficit discourse with mana-enhancing practice.
