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BPJ 57 December 2013

Best Practice Journal

Managing non-melanoma skin cancer in primary care: A focus on topical treatments

When a patient presents with a suspicious skin lesion the first step is to assess the likelihood of melanoma being present and then to provisionally identify the type of lesion. Surgical excision with histology is the first-line treatment for all skin cancer. It has the highest cure rate among available treatments. Referral, according to local guidelines, to a General Practitioner with a Special Interest (GPSI) in skin lesions, a Dermatologist, a Plastic Surgeon or an ENT Surgeon may be appropriate for patients with large lesions or lesions with an aggressive growth pattern. Patients with superficial basal cell carcinoma or intraepidermal carcinoma (squamous cell carcinoma in situ) may be safely managed with cryotherapy or topical treatments, i.e. fluorouracil or imiquimod creams, when excision is not appropriate because of the location of the lesion or due to cosmetic considerations. Topical treatments should not be considered if the diagnosis is uncertain. View Article

Biologic medicines for the treatment of inflammatory conditions: What does primary care need to know?

Patients with severe immune-mediated inflammatory diseases, e.g. rheumatoid arthritis, Crohn’s disease or psoriasis, often respond well and relatively quickly to treatment with biologic medicines such as tumour necrosis factor (TNF) inhibitors. For a patient to qualify for subsidy for these medicines, treatment must be initiated by a relevant specialist, e.g. Rheumatologist, Gastroenterologist or Dermatologist. The role of the primary care team is to facilitate discussion between the patient and the treating specialist, to reduce the risk of complications, e.g. serious infection, to provide repeat prescriptions and in some cases to monitor the patient’s response to treatment. General Practitioners may also be involved in applications for the renewal of Special Authority subsidy for patients taking biologic medicines. View Article

Managing patients with dementia: What is the role of antipsychotics?

Concerns have been raised, both in New Zealand and internationally, about the increasing off-label use of antipsychotics, and their safety profile in older people. Antipsychotics should not be considered in older people with dementia before non-pharmacological treatment strategies have been trialled. The potential benefit of antipsychotics needs to be weighed against the significant likelihood of adverse effects. The choice of antipsychotic is also important and needs to take into account both relative efficacy and safety. Antipsychotics are only useful for specific behaviours associated with dementia, such as psychosis and agitation. If antipsychotics are prescribed, response to treatment and adverse effects must be carefully monitored. View Article

The New Zealand Formulary for children

In November 2013, the New Zealand Formulary for Children (NZFC) was released. This is a New Zealand adaptation of the British National Formulary for Children. View Article

The Integrated Performance and Incentive Framework: An introduction

In October, 2013, the first draft of the Integrated Performance and Incentive Framework (IPIF) was released. It has been developed for the Ministry of Health by the IPIF Expert Advisory Group. View Article

Hazardous substances series: Pyrethroid toxicity and its management

Contributed by Dr Michael Beasley and Dr Wayne Temple, National Poisons Centre View Article