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Background/Aim To audit the doses of opioids and sedatives administered to patients in the last 24 h of life in an Australian tertiary hospital and compare results with doses published in New Zealand ( NZ) benchmarking studies and to examine the effect of caring for dying patients using a modified version of the Liverpool Care Pathway ( mLCP) in respect to doses of opioids and sedatives. Methods A retrospective chart audit of 102 patients who died in a tertiary hospital was carried out over a 3-month period in 2011. Diagnosis, demographic patient characteristics, use of the mLCP, use of subcutaneous infusions and key symptoms were identified. Chi-squared and the non-parametric Mann-Whitney tests were applied to compare the group differences for categorical and continuous variables as appropriate. Parenteral morphine-equivalent daily dose ( pMEDD) was calculated. A t-test assessed the variable mean doses of medication and patient characteristics. Results Of the audited patients, 76.5% died of non-malignant disease. The overall mean dose of midazolam was significantly lower compared with that of the NZ study pMEDD (6.0 vs 20.7 mg). The overall mean dose of morphine benchmarked closely with the NZ study (56.5 mg Australian study vs 47.8 mg NZ study). A total of 83% of patients with a malignant diagnosis was supported with the mLCP compared with 51% of patients with a non-malignant diagnosis. Conclusion The significance of the lower midazolam doses was postulated, including the possibility of inadequate symptom control for patients with a non-malignant diagnosis. The use of the mLCP did not lead to the provision of higher doses of medications. [ABSTRACT FROM AUTHOR]

Non-medical use of prescription opioids (NUPO) is an increasing public health concern in Australia and New Zealand. In response to a lack of research on NUPO in this setting, we investigated the associations between NUPO, mental illnesses, and other substance use, using data from the 2019 Global Drug Survey (GDS). Strategies to reduce NUPO-related harm were also discussed. Socio-demographic characteristics, mental illnesses, NUPO, and other substance use among 2019 GDS respondents were examined. Logistic regression was used to identify factors associated with past year NUPO. Data from 2752 Australian and New Zealand respondents who used drugs were analysed. Pastyear use of heroin, benzodiazepines, cannabis (containing THC), and ecstasy were associated with a greater odds of NUPO, while bipolar disorder managed with medications was associated with a lower odds of NUPO. All other mental illnesses, including co-morbid mental illnesses, were not associated with NUPO after adjusting for potential confounders. Of respondents who reported NUPO and answered secondary questions, 38.8% obtained opioids from a friend or family member. This study provides a unique understanding of potential risk factors for NUPO among people who report mental illness and drug use in Australia and New Zealand, and establishes a basis for future research that is aimed at reducing NUPO-related harm. [ABSTRACT FROM AUTHOR]

We present an astrochronologically constrained magnetostratigraphic age model for a middle Miocene (16-13 Ma) mudstone succession from the Bryce Burn, western Southland, New Zealand. Fourteen magnetic polarity zones were identified from magnetic remanence measurements. Eleven of the polarity zones can be correlated with the geomagnetic polarity time-scale using four biostratigraphic tie points. The magnetostratigraphically determined sedimentation rate was verified by conducting spectral analysis of an orbitally paced magnetic susceptibility record which contains obliquity and eccentricity cycles. In the Bryce Burn succession, the Lillburnian/Clifdenian stage boundary (defined at the lowest occurrence of Orbulina suturalis) occurs within Chron C5ADn and is assigned an age of 14.450 ± 0.2 Ma, which is some 650 kyr younger than the current estimate (15.1 ± 0.34 Ma). at least two hiatuses are indicated near the base of the studied succession (between 180 and 280 m; 15.3-14.3 Ma) and these are interpreted to indicate scouring by invigorated ventilation of the deep Pacific during the cryospheric expansion at the beginning of the middle Miocene climatic deterioration. [ABSTRACT FROM AUTHOR]