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BPJ 63 September 2014

Best Practice Journal

“Seventh age itch”: Preventing and managing dry skin in older people

As skin ages, increased transepidermal water loss leads to dry skin (xerosis) and reduced barrier function. Dry skin is often itchy and prone to dermatitis. Repeated scratching can lead to chronic wounds and infections, particularly on the lower legs and especially if treatment is delayed. Older patients should be asked regularly about skin symptoms and periodically examined for signs of poor skin health. Encourage older patients to use emollients (which hydrate and soften the skin) and to avoid products which irritate the skin, e.g. standard soap, to improve skin health. If patients do experience skin rash or injury, e.g. skin tears, they should be advised to seek help for this early on to reduce the risk of complications developing. View Article

Vulvovaginal health in post-menopausal women

Age-related changes in women can result in an increased occurrence of vulvovaginal dermatological conditions such as vulval dermatitis and lichen sclerosus, along with associated issues such as incontinence, recurrent urinary tract infection and sexual dysfunction. Atrophic changes during and after menopause due to declining oestrogen levels can result in a range of symptoms, including vaginal dryness and irritation as well as increase susceptibility to vulvovaginal trauma and infection. View Article

Helping patients cope with chronic non-malignant pain: it’s not about opioids

The role of opioids in the management of chronic non-malignant pain is a controversial subject due to concerns over the long-term efficacy and safety of treatment, including the risk of misuse and addiction. In the past, opioids featured prominently in many treatment guidelines for chronic non-malignant pain. However, this advice has been reconsidered in more recent times and the current opinion is that opioids have a very limited role in the management of patients with chronic non-malignant pain. Non-pharmacological methods for helping patients cope, and come to terms, with their pain should be the mainstay of treatment. Non-opioid analgesics may be considered for periods when pharmacological treatment for pain is necessary. Opioids should only be considered as a treatment of “last resort”, and should be used for the shortest possible time, at the lowest effective dose, using the least potent opioid possible. View Article

Communicating cardiovascular risk effectively

Calculating a patient’s cardiovascular risk is relatively easy; communicating this to patients in a way that assists their decision making can be challenging. This is because patients and health professionals often think differently about cardiovascular risk. To empower decision making and self-efficacy among patients clinicians can choose to frame information in a variety of different ways. View Article

Measles: what to be aware of during an outbreak

The current measles outbreak in New Zealand highlights the importance of maintaining high measles mumps and rubella (MMR) immunisation coverage to ensure that outbreaks remain as infrequent as possible. Measles is most often seen in children aged under one year who have not yet been vaccinated. However, the changes to the MMR Immunisation Schedule over the years have meant that there are still certain populations within the community who are at an increased risk of contracting and transmitting measles. View Article

Safer prescribing of high-risk medicines: Colchicine – extremely toxic in overdose

Colchicine is a plant-based alkaloid, extracted from Colchicum autumnale (autumn crocus, meadow saffron) and Gloriosa superba (glory lily) used to treat gout and some other inflammatory conditions. It is considered a high-risk medicine because it is associated with significant toxicity when not used correctly. View Article

Recommendations for good IT management for general practices

General practices are increasingly dependent on their IT systems for managing their patients and their business. Up to date and effective IT systems are an essential part of protecting electronic patient information against the risks of data loss or unauthorised access. View Article

News Updates

Does aspirin protect against cancer? More high-quality research is needed View Article

Correspondence: Oxycodone; Morphine formulations; Patients expectations

What are the real reasons behind the use of oxycodone? | Were problems with morphine formulations a factor in the uptake of oxycodone? | Managing patients expectations when prescribing oxycodone | Incorrect graphic in oxycodone article View Article

Peer Group Discussion

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