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Published: 21st December, 2023


Another year over

So, this is Christmas

Welcome to the 90th edition of Best Practice Bulletin. This is our fourth year of the Bulletin and the 25th update for 2023. We carefully curate your news every fortnight, selecting items of the most importance and practical relevance to primary care, and share with you our latest resources. We welcome our new subscribers who have joined us this year and hope that our long-term readers continue to find value in what we offer. It has been another challenging year for everyone in the health care sector. Our recommended management is a restful, long, hot summer break, taken as required, repeats available. Contraindications include obligation to provide care to the holidayers, and primary care staffing supply issues may constrain the number of people for whom current treatment is available. We hope that a waiting list is available in your area for deferred treatment.

And what have you done?

This year, you have read more than 250 items in Best Practice Bulletin and considered the findings of 25 “Paper of the Weeks”. We have published 40 new resources for our primary care audience and 12 new topics for our point-of-care guide B-QuiCK, as well as maintaining our library of over 1,000 articles and multimedia resources.

Let’s take a closer look at what your most read resources have been this year:

Another year over; And a new one just begun

We have much in store for our readers in 2024, with a new update on melatonin coming in hot in January. This article is consistently in our top 10 list, and we have now revised all the evidence and consulted with the experts on how, when, and whether to use this medicine at all. Other resources lined up in 2024 include an update on atrial fibrillation, a revision on beta blockers, an interview with the experts on last days of life, a new version of the full blood count reference guide, a report on antibiotics and some medicine selection tools. Let us know what other topics you would like to see in the year ahead:

A very merry Christmas; And a happy New Year; Let’s hope it’s a good one
Our offices will be closed from 12.30pm, Friday, December 22nd and re-open Monday, January 8th. We wish you all a very merry Christmas and festive season. We would like to thank every single reader for supporting bpacnz Publications in 2023, and particularly those who contributed to, commented on or studied every resource from start to finish. We look forward to you tuning in again next year.

Meri Kirihimete me ngā mihi o tau hou.

In case you missed it - Accelerated silicosis: diagnosis of an occupational disease

In breaking news, Australia will become the first country to ban the use of artificial (engineered) stone, due to the unacceptable risk of accelerated silicosis, a deadly occupational disease. From 1st July, 2024, the manufacture, supply, processing and installation of artificial stone will be prohibited. A national framework is being developed to protect and guide workers when modifying or repairing previously installed artificial stone. At this stage, it is not known if similar restrictions will be introduced in New Zealand.

Accelerated silicosis is a progressive respiratory condition caused by exposure to high concentrations of respirable crystalline silica (RCS). This mainly affects people involved in fabricating artificial stone into benchtops, where the RCS concentration in dust can be > 80%. WorkSafe New Zealand is currently encouraging workers to contact their primary care clinic for assessment. bpacnz has published an article covering the pathology and diagnosis of accelerated silicosis, and referral into the Accelerated Silicosis Assessment Pathway, as well as workplace safety recommendations to reduce risk.

The full article can be accessed here

Remind eligible patients about COVID-19 boosters: and don’t forget yourself

Manatū Hauora, The Ministry of Health, is encouraging people, particularly those who are older or with chronic and multiple co-morbidities, to receive an additional COVID-19 booster dose over the summer period (regardless of the number of boosters previously received).

For further information on COVID-19 vaccines, including eligibility criteria for a booster dose, see: or the Immunisation Handbook, here.

N.B. IMAC is also reminding healthcare professionals to check their cold chain set up over the summer holiday period. Click here for further information.

Results from the 2022/23 Health Survey released

The results from the latest New Zealand Health Survey have now been released by Manatū Hauora, Ministry of Health. This annual survey provides population-level data on health status, long-term conditions, health behaviours, risk factors, health service utilisation and barriers to accessing healthcare.

Whilst smoking rates continue to decrease, vaping/e-cigarette use is increasing, particularly among young adults. Also of concern, the number of people who reported waiting time as a barrier to seeing their general practitioner has almost doubled since the previous year.

Further information, including an interactive web tool, is available here. There is also an associated press release detailing some of the key findings.

Aripiprazole depot injection to be funded

Due to the ongoing supply issues affecting stock of olanzapine depot injections (as reported in Bulletins 88 and 89), Pharmac has announced that from 1st January, 2024, aripiprazole depot injections will be funded as an alternative treatment for people who meet Special Authority criteria. To meet the criteria, the patient must have already trialled a funded atypical antipsychotic depot injection (olanzapine, paliperidone or risperidone) but experienced an inadequate response, intolerable adverse effects or cannot access olanzapine due to the supply issues (or would have been initiated on olanzapine but has been unable to). Aripiprazole depot injections are not currently approved by Medsafe, so will need to be prescribed for supply under Section 29 of the Medicines Act 1981.

Paper of the Week: A light-hearted Christmas selection

Medicine: a performing art

In a thought-provoking Christmas feature article from the BMJ, renowned professor of surgical education and engagement science, Roger Kneebone, compares medicine to a performing art. This parallel is perhaps not one many would make, but as the author writes, “many clinical acts are performances” which, much like performing arts, are “rooted in a protracted grind of rehearsal, memorisation and preparation”. The clinician performs to three audiences: patients, colleagues and themselves, and their ability to perform evolves over time as clinical knowledge is acquired and practical skills are mastered (which may initially involve mirroring the behaviour of more experienced colleagues). Clinicians must be able to respond to the unexpected and have the confidence to improvise if things do not go to plan. As is the case between a performer and their audience, the quality of a clinician’s attention during a consultation is paramount, which can be challenging “within a pressured environment where the demands of the system can overshadow the needs of individuals within it”. Clinical simulation (e.g. running through or discussing procedures and consultations and receiving feedback) is one solution, in the same way dress rehearsals aid performers before a big show. Click here to read the full feature.

Kneebone R. Medicine: a performing art. BMJ 2023;383:p2710. doi:10.1136/bmj.p2710

Is singing under the Christmas tree psychologically recommended?

Could a little singing at Christmas time be backed by clinical evidence of benefit, despite the protests of all those Christmas grinches? In an editorial from Clinical Psychology in Europe, authors evaluate the psychological impact of singing under the Christmas tree. Evidence suggests that for most people who sing, their mood improves, and the most significant improvements occur when singing with others. If we want to stretch the benefits even further, singing may also have a positive effect on immunity (by increasing secretory immunoglobulin A). So, if you’re feeling a little down or stressed this holiday season, grab your friends and family and sing to your heart’s content. Which carol to choose, you ask? Well, the authors suggest that festive songs you’ve sung as a child bring the most magic. Click here to read more.

Kanske P, Rief W. Is singing under the Christmas tree psychologically recommended? A scientific evaluation. Clin Psychol Eur 2022;4:e10841. doi:10.32872/cpe.10841

This Bulletin is supported by the South Link Education Trust

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