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BPJ 59 March 2014

Best Practice Journal

Seasonal influenza vaccination: 2014 update

The vaccine for the 2014 influenza season is now available. This year, the vaccine has been updated with two new strains, as well as the previously included A(H1N1)-like virus. The three strains will provide cover for the variants of influenza currently circulating globally and likely to affect New Zealand in winter 2014. The group of people eligible for a subsidised vaccine is unchanged from 2013. All patients can be encouraged to receive the vaccine, but older people, immunocompromised people, women who are pregnant and young children will benefit the most from vaccination. In addition, it is strongly recommended that healthcare workers receive the vaccine in order to protect themselves and their patients. View Article

Meningococcal disease: Always consider in a patient with flu-like illness

Patients with meningococcal disease can initially present with non-specific influenza-like symptoms. More specific signs and symptoms may develop as the illness progresses. Symptoms can rapidly progress from mild to life-threatening, therefore suspected meningococcal disease is a medical emergency. View Article

Managing pain in children aged under 12 years

“Pain is what the patient says it is”. This definition of pain can be applied to any patient, regardless of their age. Good pain management in children involves identifying and assessing the pain, followed by prompt control of the pain through pharmacological management and resolution of the underlying cause. If unmanaged, pain can lead to anxiety and stress, and in the long-term this can impact on the psychosocial health and development of a child. Presentations of pain in children in primary care will generally fall into three broad categories: mild pain associated with childhood conditions commonly treated in general practice, acute trauma and medical situations where referral and stronger analgesia may be required, and management of pain associated with long-term conditions.

There is also a Peer Group Discussion on this article

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Glaucoma: who to refer for testing and how to manage their treatment

Glaucoma is the leading cause of preventable blindness in New Zealand and it is estimated that half of the people affected by it are undetected1. To improve detection rates every person should ideally have an assessment of their optic nerve before age 45 years, and people with risk factors examined earlier. Topically administered intraocular pressure-lowering medicines are the mainstay of glaucoma prevention and treatment. However, systemic absorption of these medicines does occur, which can result in adverse interactions with other treatments. Adherence to glaucoma treatment is a problem for many patients as the condition is often asymptomatic until it is relatively advanced.

There is also a Peer Group Discussion on this article

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The diagnosis and management of herpes zoster and its complications

Herpes zoster (shingles) is a self-limiting condition caused by reactivation of the Varicella zoster virus. Shingles most frequently develops in older people and people who are immunocompromised. Diagnosis is straightforward if the characteristic rash of shingles is present, however, patients can present with atypical features. Antiviral medicines may reduce the duration of the rash and associated pain, however, they do not reduce the risk of patients developing post-herpetic neuralgia, the most common long-term complication of shingles. View Article

Hazardous substance poisoning in children: poisons in and around the house

Children are great explorers, and preschool children spend much of their time exploring at home. This can lead to children unintentionally being exposed to a number of hazardous substances. This article describes some of the common household poisonings, outlines their management and discusses their prevention. View Article

Upfront: Responding to the challenge of falls in older people

Contributed by the Health Quality & Safety Commission View Article

News Updates

Changes to the pneumococcal vaccine for children | Annual update of the New Zealand Health Survey reveals declining smoking rates but increasing rates of obesity | Further roll-out of the Community Pharmacy Anticoagulation Management Service View Article

Correspondence: Clinical indications; Iron infusions; Link between; Authorship; Year in review

Clinical indications on prescriptions | Iron infusions in general practice | Link between irritable bowel syndrome and restless legs syndrome | A question of authorship | The year in review View Article

Peer Group Discussion

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