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BPJ 66 February 2015

Best Practice Journal

The Year in Review - What did we learn in 2014?

In 2014 we published over 60 medical education articles in Best Practice Journal, spanning more than 450 pages. Context is crucial for understanding and accepting why any recommendations are made, but if we take away the “whys, wheres and hows”, we are left with a list of key messages to guide the responsible use of medicines in primary care. Of these key messages, we consider the following to be the most essential learning points covered last year: View Article

The optimal management of patients with COPD - Part 1: The diagnosis

Chronic obstructive pulmonary disease (COPD) affects approximately one in seven New Zealanders aged over 40 years, and is the fourth leading cause of premature death, illness or impairment in this country behind heart disease, anxiety/depression and stroke. A diagnosis of COPD may be considered in adult patients with long-term exposure to respiratory irritants, e.g. cigarette smoke, or with symptoms typical of COPD, i.e. breathlessness, cough, and/or sputum production. COPD cannot be reliably diagnosed on symptoms alone and requires spirometry to confirm a diagnosis. However, in some patients it can be challenging to differentiate between COPD and asthma with chronic airflow limitation. Spirometry can be reliably performed in primary care with the appropriate training.

This is part one of a two part article Part two can be read here

View Article

The optimal management of patients with COPD - Part 2: Stepwise escalation of treatment

This article contains some information on the use of inhaled medicines for COPD treatment that is no longer current. More recent guidance is available from: “An update on the pharmacological management of stable COPD”. Information that is no longer current is indicated in pale text.

The progression of COPD can be slowed by providing support for patients to stop smoking, and encouraging regular exercise and annual influenza vaccination. The pharmacological treatment of COPD needs to be individualised according to the patient’s response; regular follow-up is an important part of this process. Short- and then long-acting bronchodilators are the mainstays of treatment, depending on the patient’s symptom severity. Reducing the risk of exacerbations and ensuring acute exacerbations are promptly and appropriately treated with oral corticosteroids and antibiotics (if indicated) are important roles undertaken in primary care.

This is part two of a two part article Part one can be read here

View Article

Essentials for people with COPD

The interventions with the greatest potential to prevent further deterioration in patients with COPD are: View Article

Overuse of benzodiazepines: still an issue?

Benzodiazepines may be considered as a short-term treatment for insomnia and anxiety; zopiclone, a benzodiazepine-like medicine, is indicated for the treatment of insomnia only. Benzodiazepines are also used in the treatment of epilepsy and as sedatives during medical procedures. Long-term use of these medicines for insomnia or anxiety is discouraged as they are associated with dependency, an increased risk of falls and dementia in elderly people, cognitive difficulties and an increased risk of motor vehicle accidents. Data from New Zealand show that patients are currently being prescribed large volumes of benzodiazepines and zopiclone. View Article

The detection and management of patients with chronic kidney disease in primary care

A New Zealand consensus statement for the management of chronic kidney disease (CKD) in primary care has recently been developed. The statement reinforces the need to view CKD as a significant contributor to cardiovascular risk and recommends that targeted testing for CKD should be linked to routine cardiovascular risk assessments and diabetes testing. Earlier detection of CKD in high-risk groups, e.g. Māori and Pacific peoples and people with diabetes, is a clinical priority. A major challenge is identifying those patients with progressive CKD who require early and intensive intervention to prevent kidney failure and the eventual need for dialysis and/or kidney transplantation. View Article

Upfront - End-of-life care for patients with chronic disease: have we made a difference?

In late 2011 we published an article on end-of-life care for patients with respiratory failure, contributed by Professor D. Robin Taylor. Professor Taylor called for a paradigm shift in the way that health care organisations and their staff provided care for patients with chronic illnesses, who are dying. Now, over three years on, we revisit Professor Taylor’s article and question whether this paradigm shift has occurred. We invited Dr Syed Hussain, Respiratory Physician and Advanced Care Planning “clinical champion” at Auckland City Hospital, to comment on how far we have come in the provision of end-of-life care, and how much further we need to go. View Article

Research updates

Shorter courses of oral corticosteroids for the management of exacerbations in patients with COPD | Diet and the risk of COPD View Article

Peer Group Discussion

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