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Adults with insomnia have difficulty initiating or maintaining sleep with adverse effects on their daytime functioning. A sleep diary can help with diagnosis
and tracking improvements.
Pharmacological approaches to managing insomnia are a second-line option for adults who do not improve sufficiently...
In 2014 bpacnz published an article on the safer prescribing of clozapine. Since this time, a number of
fatalities, along with new research, has reiterated the..
Lowering lipid levels should be viewed as one aspect of reducing a patient’s overall cardiovascular disease risk.
Treatment for HCV genotype 1b in primary care with Viekira Pak is now for eight weeks (previously 12 weeks).
People with epilepsy require good adherence to anti-epileptic medicines for optimal seizure control. However, maintaining...
There is much debate as to whether intensive blood pressure management, i.e. aiming for a systolic blood pressure less than...
Medicines for depression, suicide prevention
Our next theme will be “Managing Pain”
Optimal ICS dose for severe COPD remains unclear e.g. on the COPD tool the fluticasone dose with vilanterol is once daily...
"Fluticasone furoate 100 micrograms + vilanterol 25 micrograms (for COPD and asthma), (NOTE: Fluticasone furoate 200 micrograms
+ vilanterol 25 micrograms is for asthma only)" Yet further down on the tool it is OK to prescribe 250mcg x 2 puffs BD of fluticasone
if combined with salmeterol. [refer: http://www.bpac.org.nz/2016/copd-tool/default.aspx ]
This seems odd to suggest the dose of fluticasone can be ten fold higher with a different LABA.
Similarly the dose ranges above vary 8-fold. Perusing the GOLD guidelines, I was not enlightened. Does BPAC have
a suggestion for optimal starting dose of steroid and titrating up or down? e.g Is there any evidence of less
exacerbations (and more pneumonia) with the higher doses?
The optimal management of patients with COPD - Part 2: Stepwise escalation of treatment
Are you presuming that doctors will classify tonsillitis treatment under pharyngitis? I see many doctors are prescribing Augmentin as primary 'go to' antibiotic for uncomplicated tonsillitis (including almost every other category of infection).
Many doctors also prescribing Amoxicillin in the first instance for tonsillitis seem to be unaware of
the reaction which may result when the patient has infectious mononucleosis masquerading as tonsillitis.
Please advise on latest dosage recommendations for Phenoxymethylpenicillin in tonsillitis.
Please advise on how to make Phenoxymethylpenicillin more palatable for children - I often have to
change to Amoxicillin simply because the child spits out the Pen V. I think you should make a point of advising on the limited primary indications for the prescription of amoxicillin clavulanate and the serious side effects that this combination drug has.
Antibiotics: choices for common infections
Stephen Hoskin, a general practitioner from Te Anau sent us the following comments
Perhaps the main practical implication of these studies is to consider the patient’s condition rather than their age.
The SPRINT study applied to people living in the community and showed benefits from tight blood pressure control across all ages,
including those over 75 years old. Contrast that with an 80% higher mortality for frail elderly rest home residents with two
or more anti-hypertensives and systolic BP less than 130mmHg
Go low or no? Managing blood pressure in primary care
Richard makes excellent points, particularly re diminishing returns. I would add the following: 1. "treating by numbers" seldom makes for good
This applies both to threshold criteria (CVR) and to target BP. eg the life-time implications of a 10% 5yr CVR in a 50yr old are
very different to the implications of a 10% 5yr CVR in a 75yr old. 2. There is an opportunity-cost to be factored in when weighing up risks and benefits.
Who will miss out on health services if resources are diverted for "intensive" management of many thousands of hypertensive patients? Who will
fund all the extra consultations? Has anyone crunched the numbers? 3. Every well-intentioned lowering of treatment thresholds or lowering of
"targets", whether BP, HbA1C, cholesterol or whatever, has the unintended effect of medicalising more of the population and increasing the
number of "worried well". To quote Aldous Huxley: "Medical science has made such tremendous progress that there is hardly a healthy human left."
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