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Published: 23 December, 2021


The year in review

Once again, 2021 has been a year like no other. If the theme of 2020 was lockdowns and virtual medicine, the 2021 sequel has all that with an added feature of vaccinations, mandates and masking. The initial burst of frantic energy of primary care pulling it all together again has now settled into an air of resignation to the "new normal". No less busy of course, but perhaps a sense of the relative calm before the forecasted omicron storm. So onwards we forge into 2022 – let's just hope that we begin to see some improvement and change and it’s simply not just "2020-too".

So, what were you reading this year?

Our offices are closed from 5pm, December 23rd and re-open Monday, January 10th. Thank you for your continued support of bpacnz Publications. We look forward to sharing new content and many exciting developments in 2022.

Merry Christmas to all, and to all a goodnight...
Meri Kirihimete

New series on early detection of melanoma and post-treatment follow-up and surveillance

In the latest topic in our cancer care series, supported by Te Aho o Te Kahu – Cancer Control Agency, we discuss the early detection of melanoma, including images and tips for dermatoscopy, the chaos and clues method and clinical checklists. In people with melanoma, survival is inversely correlated with lesion thickness, therefore, early detection is key to improving outcomes. Dermatoscopy is considered an essential skill in primary care and all practices are strongly encouraged to have an appropriate dermatoscope and at least one clinician trained in its use.

Part 2 of the series provides guidance for follow-up and surveillance of patients in primary care who have undergone curative-intent treatment for melanoma. Approximately 5 – 10% of patients develop a second invasive melanoma and more than 20% develop a new melanoma in situ at some point after their initial diagnosis. Multiple factors influence the risk of local recurrence or distant metastases, but the risk is highest in the years immediately following treatment and reduces over time.

The melanoma series is accompanied by CME activities including a peer group discussion, quiz and clinical audit.

A reminder: informing patients about myocarditis

In light of the recent death of a 26-year-old male due to probable myocarditis, in which the COVID-19 Vaccine Independent Safety Monitoring Board considers to be "probably due to Pfizer COVID-19 vaccination", the Ministry of Health, Medsafe and other agencies have re-iterated their advice around communicating risk to people receiving COVID-19 vaccines.

  • Myocarditis is a rare adverse effect of the Pfizer COVID-19 vaccination
  • The risk of myocarditis is substantially greater in people with COVID-19 infection
  • Myocarditis is treatable if identified, and early detection improves outcomes
  • Most cases of myocarditis following Pfizer COVID-19 vaccination are mild and resolve within a short time with standard treatment and rest
  • Anyone receiving a COVID-19 vaccination and their caregiver (if relevant) should be told about common expected adverse effects and rare adverse effects and when and how to seek medical advice if they develop any unexpected or concerning symptoms
  • Specifically discuss the following symptoms to be alert for: chest pain, tightness or discomfort, shortness of breath, abnormal heartbeat (e.g. fluttering, rapid), light-headedness or dizziness
  • Caregivers should actively question children/adults about any symptoms and observe them for decreased activity

Read the safety communication from Medsafe here

Holiday heart

The phrase "holiday heart syndrome" refers to an acute cardiac rhythm and/or conduction disturbance associated with heavy alcohol consumption in a person with no history of heart disease. Holiday heart, naturally, is more frequently seen over the Christmas/New Year period when people tend to over-indulge. If you are on-call these holidays, test out your knowledge on what to look out for and how to treat with this Medscape short quiz.

A more comprehensive overview of Holiday Heart Syndrome is available here.

Paper of the Week: The holly and the ivy: a festive platter of plant hazards

In this year's instalment of the BMJ's light-hearted Christmas themed feature articles, the authors discuss the toxic properties of some of our most well-known yuletide plants. You can safely rock around the Christmas tree, presuming you don’t succumb to an allergic contact dermatitis, but best to resist the urge to chew on the mistletoe or decorative wreaths unless you want to spend your Christmas well acquainted with the bathroom fixtures. Quote of the article goes to the following: "Brussels sprouts, sadly, do not seem to be poisonous and will have to be endured".

Read the full article here: Huntington G, Byrne M. The holly and the ivy: a festive platter of plant hazards. BMJ 2021;375.

This Bulletin is supported by the South Link Education Trust

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