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BPJ 40 November 2011

Best Practice Journal

Prescribing atypical antipsychotics in general practice

The use of atypical antipsychotics such as quetiapine and olanzapine is increasing. In many cases, these medicines are used for “off-label” indications and this is a worrying trend given their potential for significant metabolic adverse effects. Antipsychotics are indicated for the treatment of schizophrenia and related disorders and in some circumstances to treat the behavioural and psychological symptoms associated with dementia (risperidone only). Antipsychotics are not a first-line treatment for anxiety and are not recommended for post-traumatic stress disorder or insomnia. View Article

Nausea and vomiting in pregnancy

Nausea and vomiting are very common symptoms of early pregnancy and usually resolve by 16–20 weeks gestation (most commonly by 12 weeks). In most women these symptoms can be managed with simple diet and lifestyle advice and reassurance that it will not have an adverse effect on pregnancy. Women with more severe symptoms may require pharmacological treatment and, in some cases, referral to hospital for intravenous fluids and antiemetics. View Article

Irritable infants reflux and GORD

In New Zealand, empiric treatment with omeprazole for infant irritability and reflux is increasing, despite the fact that it is not approved for this condition, is unlikely to improve symptoms and the potential adverse effects are largely unknown. Omeprazole should only be considered for infants in cases of gastro-oesophageal reflux disease (GORD) associated with severe reflux oesophagitis or failure to thrive. View Article

Smoking status and cessation support

The PHO Performance Programme aims to improve health and reduce disparities among people using primary healthcare services in New Zealand, through the implementation of key indicators. The PHO performance indicators and targets for smoking status and cessation support are discussed, along with a series of case studies focusing on smoking cessation. View Article

Upfront: Mental health issues in adolescents who have experienced abuse and neglect

In the fourth article in our series on vulnerable children and young people in New Zealand, we discuss the complex mental health needs of adolescents who have experienced violence, neglect and other forms of abuse. View Article

End-of-life care for patients with chronic disease: the need for a paradigm shift

It is increasingly apparent that our current model of care does not provide what is best for patients at end-of-life. No one clinical service is equipped to provide for the patient's needs at all stages of their illness trajectory. Contributed by Professor Robin Taylor.

There is newer/updated information related to this article: Upfront - End-of-life care for patients with chronic disease: have we made a difference?

View Article

Health literacy: a focus for the Health Quality & Safety Commission

Over half of New Zealand's adult population is believed to have difficulty understanding and interpreting health information. Dr Janice Wilson, the Health Quality & Safety Commission's Chief Executive, believes this could be creating barriers to health care and putting the welfare of some health care consumers at risk. View Article