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BPJ 71 October 2015

Best Practice Journal

Addressing mental health and wellbeing in young people

This is the first of a series of articles which will examine the diverse theme of mental health in young people. Adolescence is a time of physical and psychological maturation, changing social roles and a move away from childhood towards greater independence and responsibility. It may bring increased exposure to risky behaviours involving sex, alcohol, drugs and motor vehicles, as well as worries about body image, relationships, peer pressures and educational achievements. From puberty the incidence of mental health conditions increases, including depression, anxiety, psychosis and suicidal ideation; young people in New Zealand have one of the highest rates of suicide in the developed world. Clinicians in primary care are in a unique position to help young people navigate this transition in life. View Article

Biosimilars - what does a primary care clinician need to know?

”Biosimilars” is likely to become an increasingly familiar term for clinicians in New Zealand and worldwide. Medicines produced from biological sources (biologics) have come to play a large role in clinical practice over the last few decades, including human hormones (e.g. human insulins) and monoclonal antibodies (e.g. adalimumab [Humira] and trastuzumab [Herceptin]) made with recombinant DNA technologies. Biosimilars are comparable versions of an existing biological medicine and can receive marketing approval once patent protection has expired for the innovator (original) biological medicine. Biologics and biosimilars are most likely to be initiated in secondary care, but primary care clinicians may find it useful to have some background knowledge of biosimilars in order to provide optimal care for patients using these medicines. View Article

Improving the safety of community-based chemotherapy

Chemotherapy is predominantly managed in secondary care, but many prescriptions for oral medicines are dispensed and taken in the community. Chemotherapy medicines are cytotoxic, and their regimens are often complicated; prescribers and pharmacists need to take added care as errors can result in severe harm to patients. Defined processes when prescribing or dispensing, combined with good communication between prescribers, patients and pharmacists, improves the safety of community-based chemotherapy. View Article

Smoking cessation - helping patients stick with it, until they quit

Nicotine addiction is a disorder that should be considered at every patient contact. All patients who smoke should be encouraged to stop and provided with cessation support. All patients who want to quit smoking should be offered pharmacological cessation support. Nicotine replacement therapy (NRT) is often the first smoking cessation medicine people try and is also recommended for use by people who want to reduce the amount that they smoke. View Article

An HPV update: vaccination coverage needs to be improved

Vaccination against human papillomaviruses (HPV) is fully subsidised for girls and young women to reduce their risk of cervical cancer and genital warts. Vaccination for boys and young men also provides protection against genital warts, as well as anal and penile cancer, and indirectly provides protection against cervical cancer for any future female partners. However, immunisation rates for females in New Zealand are below target and an action plan has been published to improve vaccination coverage. Recent research suggests that HPV vaccination may provide additional benefits to women during gestation and childbirth. View Article

An update on the use of nitrofurantoin in patients with renal impairment

The Medicines and Healthcare products Regulatory Agency (MHRA) in the United Kingdom (UK) have updated their guidance to allow nitrofurantoin to be prescribed to patients with reduced renal function. The Medicines Adverse Reactions Committee (MARC) recently discussed whether a similar change in guidance was appropriate for New Zealand. It was concluded by MARC that the contraindication of creatinine clearance of < 60 mL/min for the use of nitrofurantoin, as listed on the New Zealand medicine datasheet, should remain. View Article

Correspondence: Sore throat; Cellulitis; Melatonin in practice

Should antibiotics be continued for a sore throat if GAS negative? | Is co-trimoxazole an appropriate treatment for cellulitis? | Melatonin in practice View Article

Peer Group Discussion

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