Watch the April clinical update from Jo Scott-Jones joined by Dave Maplesden, Pinnacle GP liaison in this 30 minute video. (Written version below.)
Clinical snippets are now available as a podcast too! Search on your favourite podcast platform for The New Zealand General Practice Podcast to listen, or click here to listen on Anchor.
Some useful resources for parents while they wait include (Goodfellow Gem):
For clinicians: Regional clinical pathways. Also links to multiple resources for patients and whanau together with advice on management and monitoring.
Private options include: https://www.nzeatingdisordersclinic.co.nz
BPAC has recently released an update on weight loss: the options and the evidence. Some key practice points include:
There are two new pharmacological interventions approved in New Zealand (but not funded) for weight management:
Liraglutide (a GLP 1 receptor agonist – Saxenda) – daily SC injection, cost about $500 per month
Naltrexone + bupropion (Contrave) – tablet uptitrated over 3 weeks, cost about $220 per month
Cost comparison: phentermine Duromine (30mg caps) $100/month; orlistat (Xenical) $180/month
Indication: BMI ≥30 or 27-30 if at least one weight-related co-morbidity
Recent Tools for Practice question: Is naltrexone/bupropion (Contrave®) effective for weight loss?
Bottom line: Over 28-56 weeks, at best, ~50% of patients taking naltrexone/bupropion achieved a >5% loss in body weight, compared to ~20% in control. Naltrexone/bupropion adverse events (examples nausea, constipation) lead to withdrawal in 23% of patients versus 12% on placebo.
In the April 2022 NZF update a change to dosing recommendation for Depo-Provera is noted as:
All patients who smoke should be encouraged to stop and provided with cessation support, including both behavioural and pharmacological treatment. Currently, the options for pharmacological support are limited due to supply constraints.
A recent Goodfellow Gem looked at the work of a Canadian panel that filtered 74,000 papers to get a summary for chronic pain management of osteoarthritis, low back pain, and neuropathic pain. The findings are summarised in a table that might be useful for discussion with patients.
Some findings of note include:
Findings of a recent Coronial inquest into the deaths of five people who were killed in 2015 and 2016 by patients who were in a florid psychotic state have been summarised in GP Pulse with learnings for GPs documented as: