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BPJ 55 October 2013

Best Practice Journal

Non-steroidal anti-inflammatory drugs (NSAIDs): Making safer treatment choices

Non-steroidal anti-inflammatory drugs (NSAIDs) are successfully used to treat a wide range of painful conditions. However, NSAIDs should be prescribed with caution as courses of just a few days, even at doses within prescribing recommendations, can be associated with serious adverse effects in susceptible patients. In primary care, paracetamol is recommended in preference to NSAIDs, where appropriate. If a patient is likely to benefit from NSAID treatment naproxen or ibuprofen are recommended first-line, at the lowest effective dose, for the shortest possible time. Patients taking NSAIDs who are at increased risk of complications require regular monitoring. View Article

Calcium pyrophosphate deposition disease: The arthropathy formerly known as “Pseudogout”

A number of clinical syndromes are associated with the precipitation of calcium pyrophosphate dihydrate crystals in and around joints. These syndromes have previously been referred to by terms such as “pseudogout” or “pseudo-osteoarthritis”, but these terms are no longer favoured. Instead, the syndromes are grouped under the umbrella term calcium pyrophosphate deposition (CPPD) disease. The deposition of calcium pyrophosphate crystals results in an inflammatory reaction within the joint in a similar way that precipitation of monosodium urate monohydrate crystals does in patients with gout, and can contribute to significant chronic degenerative change in joints. Patients with CPPD disease can be asymptomatic or present with a range of symptoms and signs similar to gout or other forms of inflammatory arthritis, making an accurate clinical diagnosis difficult. In addition, unlike for gout, there is a relative lack of evidence-based research on the syndromes caused by CPPD and there is no specific medicine that can decrease the concentration of crystals. Management is therefore targeted at symptomatic relief only. View Article

Urinary incontinence in adults

Managing urinary incontinence goes beyond just treating the medical condition. For the patient, the social and psychological impact of incontinence can far exceed the extent of the clinical problem. Incontinence can lead to depression, sexual dysfunction and social isolation. Once the type, cause, severity and impact of the patient’s incontinence are determined, management involves exercise programmes and lifestyle changes. Pharmacological and surgical interventions are then considered if lifestyle intervention is insufficient. View Article

How to increase the uptake of cervical screening: A profile of success

A cervical smear test is an effective method for the early detection of cervical cancer, and for reducing cancer mortality. However, testing rates fell in 2012, and the rate of screening among women in high need groups remains significantly lower than the total population. We interviewed managers and clinicians from three successful regional cervical screening programmes, and present their advice on how primary care can increase the uptake of cervical screening, especially for women in the high need group. View Article

Health literacy plays an important role in boosting cervical screening uptake

Susan Reid and Carla White from health literacy and communication specialists, Workbase, explain how understanding and reducing the health literacy demands upon patients can make a difference. View Article

The elite athlete-patient: a fresh clinical challenge

Associate Professor David Gerrard is a sports physician at the Dunedin School of Medicine, University of Otago. He gives an insight into the challenges faced by clinicians when providing care to elite athletes. When considering treatment options, it is important to be aware of which medicines are subject to restrictions under the World Anti-Doping Agency list of prohibited substances. View Article