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BPJ 58 February 2014

Best Practice Journal

The year that was: Key messages from Best Practice Journal 2013

2013 began with publication of the 50th issue of Best Practice Journal. In this edition we focused on the topic at the heart of primary health care in New Zealand: cardiovascular disease. It is a worrying statistic that cardiovascular disease is the leading cause of mortality in New Zealand, and that significant ethnic disparities exist in the prevalence of disease, access to treatments and overall health outcomes. Other important themes of BPJ in 2013 included promoting the safe use of medicines, profiling new treatment options and raising awareness of antimicrobial resistance. Before we move on to the articles of 2014, it is important to review what we have learnt so far. View Article

Irritable bowel syndrome in adults: Not just a gut feeling

Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder characterised by recurrent bouts of abdominal discomfort and pain, bloating and a changeable bowel habit. Generally a patient with IBS will have periods of time when they feel well, interspersed with acute bouts of their particular gastrointestinal symptoms. IBS is regarded as the most frequently encountered gastrointestinal diagnosis in primary care. In some patients, IBS can significantly affect quality of life, however, reassurance can be given that IBS itself does not predispose the patient to life-threatening disease. Patients with IBS tend to be high users of health care services and some patients invest a significant amount of time and money on dietary modification and over-the-counter remedies in an attempt to control or relieve their symptoms. Ongoing research is changing the way IBS is viewed and this is providing evidence for new treatment approaches.

There is also a Peer Group Discussion on this article

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The management of Parkinson’s disease: Which treatments to start and when?

The treatment of patients with Parkinson’s disease usually involves a multidisciplinary approach to care. The role of the general practice team is to co-ordinate an individualised treatment plan, according to the progression of the patient’s condition. A combination of levodopa with carbidopa or benserazide is generally the first-line pharmacological treatment for functional disability in patients with Parkinson’s disease. A crucial aspect of management is the optimisation of treatment as new symptoms develop. Dopamine agonists, e.g. ropinirole and pramipexole, and other medicines may be required to reduce motor symptoms and to minimise the adverse effects of levodopa treatment. Non-motor symptoms, e.g. pain, depression and fatigue, are very common in patients with Parkinson’s disease and their management becomes increasingly important as the patient’s condition progresses.

There is also a Peer Group Discussion on this article

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Getting to know patients with type 2 diabetes and poor glycaemic control: One size does not fit all

People with type 2 diabetes and poor glycaemic control (HbA1c > 64 mmol/mol) are at increased risk of developing diabetes-related complications and cardiovascular disease. Engaging with these patients and helping them overcome their individual barriers to achieving a healthier life are a priority for primary care. Where possible, the family/whānau of the patient should be encouraged to be involved in lifestyle changes. Diabetes management plans should be agreed upon using a shared decision-making approach. Treatment targets, including glycaemic control, need to be individualised taking into account patient characteristics, such as age, treatment preference or the presence of co-morbidities. Primary care, nurse-led diabetic clinics are an effective way of engaging with and monitoring patients with type 2 diabetes. View Article

News Updates

Captopril tablets discontinued: ACE inhibitor alternatives | Removal of Special Authority for combination inhaler Seretide | Rotavirus and varicella vaccines on immunisation schedule from 1 July 2014 | Oral ketoconazole tablets discontinued worldwide View Article

Correspondence: Prescribing salbutamol; Are two vaccinators better than one?

Prescribing salbutamol and oral corticosteroids in a child with wheeze | Are two vaccinators better than one? View Article