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Published: 6 May, 2022


New article - Scabies: diagnosis and management

Scabies is a highly contagious skin infestation that can often rapidly spread through households before it is detected. The characteristic pruritic rash is caused by a delayed hypersensitivity reaction to the eggs, faeces and saliva of the scabies mites, and therefore it may not develop until weeks after the initial infestation. Usually by the time the patient develops symptoms, scabies transmission will have already occurred. Consider the possibility of scabies in any situation where multiple household members report pruritus. Prompt treatment prevents ongoing transmission, and reduces morbidity and development of secondary complications, e.g. cellulitis, acute rheumatic fever.

Read the full article here.

Mask exemption cards available end of May

The Ministry of Health has announced that from 31 May, 2022, people will be able to apply for a mask exemption card. This will be conclusive evidence of a person's mask exemption status and replaces existing mask communication cards and other non-standard exemptions. An exemption card can be applied for by the person via the Ministry of Health website from 31 May (medical practitioner input is not required). This page also provides useful advice for people who find wearing a mask difficult that may help them to wear a mask more comfortably.

Widened access criteria for antiviral COVID-19 treatments

As of 5 May, 2022, PHARMAC has widened the access criteria, and made this consistent for the three funded antiviral treatments for COVID-19: ritonavir (Paxlovid), molnupiravir (Lagevrio) and remdesivir (Veklury). The extended conditions will now include people with Down syndrome or sickle cell disease; and in conjunction with other risk factors, people aged over 65 years and people who have not completed a full course of vaccination against COVID-19. Further details are available here.

Cancer medicine report: understanding the gap

Te Aho o Te Kahu, Cancer Control Agency, has released a report that analyses the availability of funded cancer medicines in New Zealand compared to Australia, and examines the reasons for any differences. It is known that there are fewer cancer medicines funded in New Zealand compared to other high-income countries with similar health systems. The report identified 20 instances of a medicine-indication gap where a medicine (or medicines) was funded for a particular type of cancer in Australia, but not in New Zealand, and the medicine would offer substantial clinical benefit. In three of these instances, the medicines are used alongside surgery with curative intent (for breast cancer and melanoma). The other instances concern medicines used with the intent of prolonging or improving quality of life. It is noted that many of these medicine-indication gaps are under active assessment or have already been assessed and are options for investment by PHARMAC. N.B. Medicines for blood cancers were not included in the analysis.

Read the report here.

Notifying dog bites

A new guideline has recently been published by Starship Child Health on the management of dog bites and other dog-inflicted injuries. This is a growing cause of injury in New Zealand and in particular poses a risk to children. The guideline covers wound management and antibiotic treatment, as well as emphasising harm prevention strategies.

The guideline strongly recommends that health professionals notify dog bite injuries to the local council animal management service. For some primary care health professionals, this may not be a role that they have traditionally taken on. However, if it is unlikely that the patient or caregivers will report the injury, and there is an ongoing patient (or community) safety risk, then the health professional should take responsibility for notification. In some scenarios, the police or Oranga Tamariki may also need to be notified about the incident.

Read the guideline here.

New Zealand Formulary updates for May

Significant changes to the NZF in the May, 2022, release include:

Social license for health data use

The Ministry of Health has commissioned a survey to understand the perceptions of people in terms of use of their health data, thereby creating a "social license" for use. The analysis was carried out by the University of Auckland. Among the 2,572 participants, 74 - 76% were comfortable with their health data being used for the presented scenarios (e.g. to make decisions about your health now, in the future, to share with other health professionals, to make decisions about improving health care). Support was conditional on their data being used for the right purposes (e.g. to improve healthcare for others), securely stored, kept confidential and accurate. Most respondents were not comfortable with their data being used outside of the healthcare setting or for commercial purposes.

Read the full report here.

Paper of the Week: avocados – not just the domain of the millennials

A recent paper published in the Journal of the American Heart Association has found that higher avocado intake is associated with a significantly lower risk of cardiovascular disease (CVD) and coronary heart disease. In a study of almost 70,000 women and over 40,000 men who did not have a history of cancer, coronary heart disease or stroke at baseline, followed up for thirty years, it was found that those who had two or more servings of avocado per week had a 16% lower risk of CVD and 21% lower risk of coronary heart disease. There was no significant association with a lower risk of stroke. The authors concluded that CVD risk could be lowered by 16 – 22% by replacing half a serving per day of high fat content foods such as margarine, butter, egg, yoghurt, cheese or processed meat with the equivalent amount of avocado.

Therefore, avocados may be worthy of more attention than simply being a meme for why millennials cannot get into the housing market (too much money spent on avocado toast for brunch at trendy cafes apparently!). Replacing animal fats with plant-based healthy fats in the diet is likely to result in positive health outcomes, not to mention being better for the environment.

Pacheco L, Li Y, Rimm E, et al. Avocado consumption and risk of cardiovascular disease in US adults. J Am Heart Assoc 2022;11:e024014.

Five-minute read: what are GPs for when the chips are down?

What are GPs for, when the chips are down? A cynical, but humorous look at the future of general practitioners – a perspective from the UK, but likely to resonate with many GPs in New Zealand.

This Bulletin is supported by the South Link Education Trust

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