Watch the October clinical update from Jo Scott-Jones joined by Dave Maplesden, Pinnacle GP liaison in this 34 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.
A Research Review educational article on heavy menstrual bleeding was published last month. This includes helpful management algorithms and advice and is well worth downloading for easy reference.
Take home messages include:
A recent tools for practice compared levonorgestrel intrauterine systems for heavy menstrual bleeding compared with standard oral treatments (NSAID, TXA. COC and progestagen only pills).
The review concluded: Compared to other treatments (example oral contraceptives), blood loss with an IUD is reduced ~80% versus 25%, more women with an IUD are satisfied (75% versus 60%), and more remain on treatment at 2 years (64% versus 38%).
(i) A patient in his mid-50s presented with a five-month history of a left submandibular lump which he felt may be slowly growing. Examination unremarkable other than a firm painless 3cm lump in the submandibular region diagnosed as possible reactive lymph node and patient advised to return if it persisted beyond another three months or grew. Returned in four months as lump unchanged. Noted to have likely dental infection/poor dental hygiene treated with antibiotics and lump attributed to this. Similar return advice provided. Patient reviewed in another medical centre six months later because the lump had grown further – immediately referred and diagnosed with adenoid cystic carcinoma with pulmonary metastases.
(ii) HealthPathways section ‘neck lumps in adults’ refers to the MoH neck lump ‘HSCAN’ criteria as:
Unexplained neck or salivary mass and 1 or more of:
(iii) Management advice includes:
(iv) There are several Mercy Ascot learning modules on neck lumps and related topics that are a useful refresher on the subject.
A recent research review speakers series on management of fever in children include reference to the 2022 Starship Hospital guidance on management of fever in children under two months of age. Recommendations are summarised as:
A recent GP Pulse included an opinion piece on the inequitable state of palliative care in New Zealand, largely due to under-resourcing and lack of central planning. The report noted a recent case of a woman in her 90s is an all-too-common scenario. Her daughter had set up her home to care for her mother until she died, as was her wish. Sadly, towards the end she developed some pain and required morphine. There were no doctors available at that time of night to make a house call, so she had to go to the Emergency Department to have it administered. She died in an ED cubicle a while later – not at all what she and her family had hoped for.
For GPs wanting to take a more active and proactive role in end of life care of their patients, the Ministry of Health resource Te Ara Whakapiri toolkit is worth downloading and gives very practical advice on proactive assessment and planning to ensure the patient’s needs are established and met, recognising the dying patient and specific symptom control strategies.
From July, 2023, the primary method for cervical screening will test for human papillomavirus (HPV), the cause of over 95% of cervical cancers. Self-testing will be an option for everyone.
Spironolactone and binge drinking: A group of American researchers found that spironolactone reduced binge drinking in mice and reduced self-administration of alcohol in rats without adversely affecting food or water intake or causing motor or coordination problems. They then retrospectively analysed electronic health records of patients drawn from the United States Veterans Affairs healthcare system to explore potential changes in alcohol use after spironolactone treatment was initiated for other conditions and found a significant link between spironolactone treatment and reduction in self-reported alcohol consumption, with the largest effects observed among those who reported hazardous/heavy episodic alcohol use prior to starting spironolactone treatment. The action may relate to spironolactone’s mineralocorticoid blocking effect on the amygdala.