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BPJ 60 April 2014

Best Practice Journal

Managing patients with renal colic in primary care: Know when to hold them

Approximately one in ten people will be affected by renal colic at some stage in their life. Patients with red flags should be referred for emergency treatment immediately. However, patients with an uncomplicated presentation of renal colic can often be managed in primary care, following prompt referral for imaging to confirm the diagnosis (same-day if possible). Non-steroidal anti-inflammatory drugs (NSAIDs) are generally preferred over morphine for pain management in patients with renal colic. Most urinary stones will pass spontaneously, however, alpha-blockers are now recommended to accelerate their passage. View Article

The ankle-brachial pressure index: An under-used tool in primary care?

Calculating a patient’s ankle-brachial pressure index (ABPI) is a simple, low-cost and non-invasive way of detecting peripheral artery disease in the lower limbs. Atherosclerosis is the most frequent cause of peripheral artery disease and the patient’s atherosclerotic burden is reflected by the degree to which their ABPI is reduced. Measuring ABPI therefore provides a useful window into what is happening in the cardiovascular system and an additional prognostic tool to that provided by more frequently used surrogate markers of cardiovascular risk. Targeted testing of ABPI for people most at risk of developing peripheral artery disease and its complications, in combination with routine cardiovascular risk assessments, will lead to earlier and more appropriate treatment of all types of atherosclerotic disease.

There is also a Peer Group Discussion on this article

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A conversation about gout…

In New Zealand, the majority of people with gout have higher than optimal serum urate levels. A primary reason for this is a lack of understanding of what gout is and of the need for ongoing treatment. Effective communication and educating patients about their condition improves their long-term outcomes. We interviewed Leanne Te Karu, a Pharmacist Prescriber from Taupo with a special interest in managing patients with gout, about why she thinks the message is not getting through. We discuss her approach to helping increase people’s knowledge of gout, and include simple strategies to improve communication, enhance understanding and improve the health and quality of life of people with gout.

For updated recommendations on the management of gout in primary care, see: "Managing gout in primary care. Part 1 – Talking about gout: time for a re-think"

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Pertussis immunisation in pregnancy

New Zealand is slowly emerging from its most recent outbreak of pertussis. The highest-risk period for pertussis in infants is in the first six months of life, prior to the completion of their full course of infant immunisation. Almost all deaths due to pertussis occur in infants aged six months or under. Improving total immunisation coverage remains the best means of protecting young children from pertussis. However, pertussis immunisation of the mother while pregnant provides some passive immunity to the infant during their first six months of life, so is strongly recommended. View Article

Update on the Adverse Drug Reaction reporting tool

Reporting suspected adverse drug reactions enables the collection of information on the safety and quality of medicines and vaccines after they have been approved. An electronic adverse reaction reporting tool was launched in New Zealand in 2009. The reporting tool was designed to make the process of reporting events easier by pre-populating patient details, allowing more data to be included and enabling more timely advice to be provided to prescribers. In the five years since it’s launch, electronic notifications using the ADR tool have doubled. View Article

Contact dermatitis: a “working” diagnosis

Contributed by: Dr Lissa Judd, Occupational Dermatologist, Wellington View Article

News Updates

Simvastatin and atorvastatin: beware of potential CYP3A4 interactions when prescribing other medicines View Article

Upfront: Azithromycin: use it wisely

Growing use of azithromycin in New Zealand means that we are in danger of increasing bacterial resistance to macrolide antibiotics, as has been the case in other countries. Macrolides are particularly important in New Zealand given our high rates of pertussis and rheumatic fever. It is not too late to act; azithromycin should only be prescribed for specific indications to make sure it works when we need it the most.

There is also a Peer Group Discussion on this article

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Correspondence: Metronidazole for giardiasis; Home-made oral rehydration solution

Treatment duration of metronidazole for giardiasis | Formula for home-made oral rehydration solution View Article

Peer Group Discussion

We look back at the key messages and practice points from selected articles in Best Practice Journals View Article