Watch the February clinical update from Jo Scott-Jones joined by Dave Maplesden, Pinnacle GP liaison in this 25 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.
From a recent Tools for Practice: In patients with PAD, exercise therapy improves maximum walking distance and pain-free walking distance by up to ~200 meters over 2 to 78 weeks compared to usual care. No benefit has been demonstrated for amputation or mortality. The most commonly studied exercise is supervised walking 2-3 times per week for 30-60 minutes, although other supervised activities (example resistance training) may be beneficial in those who cannot tolerate walking.
Last year MCNZ released an updated statement on use of the internet and electronic communication which includes the following points (and I recommend reviewing the whole document).
A recent article in NZ Doctor includes the following key points on recurrent BV.
DermnetNZ lists a number of alternative treatments including gels to reduce vaginal pH and a vaginal antiseptic dequalinium. It does not appear any of the recommended products are in NZF but Aci-Jel is available OTC (around $30 per 100g tube). Boric acid vaginal pessaries can be bought online, e.g. pHD $199 for 72 caps (about five courses).
A 2009 Cochrane review concluded that research at that time did not provide conclusive evidence that probiotics are superior to or enhance the effectiveness of antibiotics in the treatment of BV. However, a 2019 meta-analysis concluded that probiotic regimes are safe and may exhibit a short-term and long-term beneficial effect for BV treatment. There are many OTC preparations available. Probiotics do not form part of HealthPathways or Aotearoa New Zealand STI Management Guidelines recommendations for management of BV.
DermnetNZ also discusses cytolytic vaginosis as a cause of possible of persistent vaginal discharge. This is the result of a hyperacidic vaginal environment due to overgrowth of lactic acid producing bacilli, with management aiming to reduce vaginal pH (baking soda douching).
Tools for Practice examined the evidence around effectiveness of intrauterine devices for prevention of pregnancy when used beyond the manufacturer recommended use period. The conclusion was:
If it is not possible or desirable to replace a levonorgestrel 52mg or copper-T380A intrauterine device (IUD) at the end of the approved duration of use, small observational studies demonstrated similar efficacy and safety for up to two additional years, with little evidence afterwards. Guidelines suggest that with patient-informed discussion, deferral of IUD replacement for up to 12 months is reasonable.
A useful tool is available from NPS Australia that assists prescribers when changing a patient's antipsychotic treatment. Using the interactive tool, the prescriber enters the formulation (oral or depot), the current medicine the patient is prescribed and the medicine they want to switch the patient to. This then generates prescribing information about how to stop one medicine and start the next, along with key clinical issues to be aware of. All antipsychotic medicines currently funded in New Zealand are included in the tool.
A relatively common prescribing complaint I see relates to patients concerned they were not warned of the risk of serotonin syndrome, or that they experienced serotonin syndrome, usually secondary to co-prescribing of two serotonergic agents. The most common combinations I see are tramadol and SSRI, SNRI or TCA, or when a TCA is added to an existing antidepressant regime. A 2015 communication from Medsafe discusses the issue in more detail and is worth a quick review.
2020 has been designated as the year of the nurse and the midwife by the World Health Organization, and Pinnacle is very keen to support this.
Read morePathlab want to re-emphasize the importance of correct labelling of specimens to facilitate optimal processing of patient samples. The consequences of a labelling error not being detected or resolved can result in avoidable patient harm.
This service is designed to ensure low acuity presentations to Taranaki Base Hospital are actively redirected back to primary care.
View detailsPinnacle is a recertification programme provider partner for designated registered nurse prescribers in community health (RNPCH).