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Published: 3 February, 2023


In case you missed it: latest articles

February is Ovarian Cancer Awareness Month

This month is Ovarian Cancer Awareness Month. Ovarian cancer is the second most common gynaecological cancer after endometrial and has a higher mortality than all other gynaecological cancers in New Zealand combined.

There is no effective screening test for ovarian cancer, so diagnosis relies on the prompt recognition and investigation of suspicious symptoms. While ovarian cancer was historically considered to be a silent disease in its early stages, evidence suggests that 90 – 95% of people are symptomatic, although symptoms are often vague and non-specific. Clinicians should be alert for potential symptoms of ovarian cancer and have a low threshold for initiating further investigations in people with suspicious symptoms.

This month we will be publishing an article on the early detection of ovarian cancer. This article is part of a series on gynaecological cancers, supported by Te Aho O Te Kahu – Cancer Control Agency. The first article of this series, Cervical cancer: early detection and referral was published last year; keep an eye on our website and watch your inbox for new resources as they are published.

Fluoxetine 20 mg capsules supply issue: dispensing limit in place

It has previously been announced that the funded brand of fluoxetine 20 mg capsules is changing from Fluox to Arrow-Fluoxetine, with Fluox to be delisted on 1 June, 2023. However, Pharmac reports that stock of Fluox has now been exhausted; the brand change has therefore occurred earlier than expected causing a supply issue with Arrow-Fluoxetine.

Limited supply of Arrow-Fluoxetine is likely to continue throughout February, 2023. Stock is expected to arrive this month; however, it may take time to restock all pharmacies.

A dispensing limit (see “Read more”) is now in place until 28 February, 2023, when it is anticipated that the supply issue will be resolved. The situation will be monitored, and the limit removed earlier if supply becomes available.

Reminder: reporting hazardous substances-related diseases and injuries

By law, injuries and diseases due to hazardous substances (see below) must be notified to the Medical Officer of Health. BPAC Clinical Solutions, in association with EHINZ and funded by Manatū Hauora, Ministry of Health, has developed a Hazardous Substances Disease and Injury Reporting Tool (HSDIRT), for electronic reporting of all hazardous substance exposures. It is available via Medtech, Indici, MyPractice and Profile practice management systems. Electronic reporting meets the legal requirement for notifying the Medical Officer of Health. Clinicians who do not use electronic reporting must contact the Public Health Unit directly.

Click here to view a short video explaining how to access and complete HSDIRT notification forms

To get bestpractice Decision Support software for your practice, contact the BPAC Clinical Solutions Helpdesk:

Phone: 0800 633 236
Website contact form:

A practical example of using HSDIRT: Childhood poisonings: hazardous substances around the home

The natural curiosity of young children about their surroundings can sometimes lead to unintentional exposures to hazardous substances around the home. In this article, we take a general look at the triage and management of children exposed to common household poisons, including household-related chlorine exposure. It would be appropriate to use the HSDIRT tool following many of these scenarios.

Contact the National Poisons Centre if there is any uncertainty in the management of a child who has been poisoned.

A B-QuiCK summary is available for this topic.

NZF updates for February

You can also read about any significant changes to the NZFC, here.

Revised Mental Health Act Guidelines: e-learning modules and resources now available

Te Pou, a national workforce centre for mental health, addiction and disability in New Zealand, has developed a suite of resources, supported by Manatū Hauora, Ministry of Health, for people being assessed and treated under the Mental Health Act, and for their family/whānau. These resources have been developed in response to the 2022 revised Mental Health (Compulsory Assessment and Treatment) Act 1992 Guidelines.

A series of free e-learning modules have also been released to support healthcare professionals in applying the changes to the Mental Health Act, particularly in adopting a person-centred, human-rights based approach to situations where the Mental Health Act is used. Three modules are available:

  • Module 1: A general introduction to the changes for anyone in the health workforce
  • Module 2: For the mental health workforce
  • Module 3: For specialist mental health workforce who implement the Mental Health Act

Paper of the Week: New study may help determine which older people with vague symptoms have cancer

This week we depart from our usual paper of the week to share with you a short interview-style podcast from the British Journal of General Practice, with the lead author of a 2023 paper that studied cancer risk in patients with fatigue and other vague symptoms.

Fatigue is a relatively common and non-specific symptom that most people experience at some point in their life. For many people, the underlying cause is benign, but for some, the cause of their fatigue is something more concerning. The optimal investigation and management of a patient with vague and non-specific symptoms is often challenging in primary care. It is also difficult to judge which patients require investigation for cancer when there are no red flags or specific symptoms present to guide this decision.

The study was conducted using clinical records of patients who presented to primary care in the United Kingdom with fatigue and no red flag symptoms of cancer. The study looked at whether patients had other vague symptoms present, e.g. weight loss, abdominal pain, in addition to fatigue. During a nine-month follow-up period, researchers analysed how many patients were diagnosed with cancer to identify which sex, age group and combination of symptoms were associated with the highest risk of disease. All diagnoses of malignant neoplasms were included in this study except non-melanoma skin cancers.

The author of the paper explains in the podcast that among patients without red flag symptoms for malignancy, the risk of cancer was > 3% for older males and females with fatigue and another vague symptom, in particular weight loss, abdominal pain or abdominal bloating. The risk of cancer exceeded 6% in some older male patients with fatigue and weight loss or fatigue and abdominal pain. The study did not differentiate which specific cancers or organ sites were associated with fatigue, or other vague symptom combinations.

If an older patient presents with fatigue, ask about the presence of any other vague symptoms, particularly weight loss or abdominal pain, and if present, consider the possibility of malignancy even if there are no red flag symptoms of cancer.

Listen to the full podcast here: (15 minutes)

Read the full article here:

This Bulletin is supported by the South Link Education Trust

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