Published: 29 October, 2021
New article: Lung cancer follow-up and surveillance: the role of primary care
in our lung cancer series we focus on the role of primary care in supporting people and their whānau after treatment for lung cancer.
Transitioning from active treatment to post-treatment care is an important milestone in the long-term health of patients who have undergone curative-intent treatment
of lung cancer. Primary care is well placed to offer follow-up and supportive care to the patient and their family/whānau that includes
monitoring for cancer recurrence and reducing the physical and psychosocial impacts of cancer and its treatments.
Next week (1–7 November) is the sixth annual #MedSafetyWeek. This is a social
media campaign supported by medicine regulators and their stakeholders from 64 countries
across the world, that aims to raise awareness about the importance of reporting suspected adverse effects. This year’s theme is vaccine safety. In New Zealand, suspected
adverse effects to vaccines, or any other medicines, can be reported to the Centre
for Adverse Reactions Monitoring (CARM) or directly via your practice management
software. A dedicated site for reporting adverse effects related to COVID-19 vaccination is
New cause of death for medical certification of death
The Ministry of Health has announced that ‘Frailty
of old age’ can now be entered as the sole entry in Part
1(a) of a medical certificate of cause of death (MCCD) in limited circumstances, effective immediately. This diagnosis
is applicable to a patient aged ≥ 80 years who dies as a result of gradual multi-system decline in function, that:
- Has been clinically assessed over a period of several months or years for the specific organ system disease before
- Is attributable to atrophic degenerative changes of ageing; and
- Has occurred in the absence of any specific organ system disease
This change is intended to offer a more suitable option for health practitioners to use when completing the MCCD for
an elderly frail patient who has died suddenly, apparently of natural causes, but the exact cause of death cannot be determined
without an autopsy.
Filling out the MCCD
If there is a more specific chronic diagnosis that has resulted in death, or if death is due to acute illness or trauma, these should be preferentially entered
in Part 1a. If ‘Frailty of old age’ is used as the diagnosis in Part 1a, any additional chronic conditions that contributed to the patient’s steady decline should
be entered in Part 2 of the MCCD in order of severity, in addition to the corresponding time interval in brackets after each condition. A digital tool
for completing MCCD is available on the Death Documents website.
Funded brand of melatonin is changing
PHARMAC has announced
that the funded brand of melatonin (2 mg prolonged release tablet) is changing. This formulation of melatonin is the only strength that is funded
(with Special Authority approval). It is funded for people aged < 18 years who have persistent and distressing insomnia secondary to a neurodevelopmental disorder such as
autism spectrum disorder or attention deficit hyperactivity disorder. The current funded brand, Circadin and the new funded brand Vigisom are produced by the same manufacturer
and have the same active ingredient. The brands are similar in appearance, i.e. small, round white tablets, but the name and the packaging will be different. Vigisom will be
fully funded from 1 November, 2021 and the Circadin brand will be delisted from 1 April, 2022. A brand switch fee will be available for pharmacists
from 1 November, 2021 until 30 May, 2022.
PHARMAC medicine supply issues
The following issues relating to medicine supply have recently been announced by PHARMAC
Furosemide (Urex Forte)
The supplier of Furosemide (Urex Forte) 500 mg has advised
that the medicine is out of stock due to manufacturing delays. Supply is expected to
resume during December, 2021. The supplier has sourced an alternative product – Furosemid-Ratiopharm 500 mg – which can be prescribed during the
period that Urex Forte is out of stock. However, this alternative is not Medsafe approved, and therefore needs to be prescribed for
supply under section 29.
Oestradiol valerate (Progynova)
Bayer has advised that
there will be a brief supply issue for the Progynova brand oestradiol valerate 2 mg tablets, which is anticipated to
resolve by late November 2021. In addition, the 2 mg tablets will be permanently changing colour from blue to white. The Progynova brand of
oestradiol valerate 1 mg tablets will not be affected by this supply issue and will remain the same colour.
Guidance for COVID-19 vaccine exemptions
We are entering a crucial phase of the COVID-19 vaccine rollout now that the government has announced
vaccination targets for District Health Boards (≥ 90% of the eligible
population fully vaccinated). Many people remain unvaccinated, and considering the mounting social pressures around this position, health practitioners may have had increasing
enquiries regarding vaccination exemptions. As outlined by the Immunisation
Advisory Centre (IMAC) and reported in Bulletin
35, a history of anaphylaxis to a previous dose
of the Pfizer-BioNTech COVID-19 vaccine or its contents, e.g. polyethylene glycol (PEG), may constitute a contraindication to vaccination. However, it is important to discuss
such patients with an immunologist as it may still be possible to vaccinate them in a specialist immunology clinic under carefully controlled conditions. Being
immunocompromised is not a contraindication to COVID-19 vaccination – people in this group are among those who will benefit the most from receiving the vaccine, and some will
even be eligible for a third primary dose.
As the Pfizer COVID-19 vaccination has been linked to a small
increased risk of myocarditis, a vaccine exemption may be appropriate for patients
with a current significant inflammatory cardiac condition.
Important note: IMAC and the RNZCGP are working with the Ministry of Health to publish guidance on what constitutes a medical exemption for vaccination.
This is expected within the next week. Current information on vaccine exemptions and how to apply is available on the Ministry
of Health website, but it is important to check back regularly for any changes.
FDA panel votes to approve the Pfizer-BioNTech COVID-19 vaccine for children
An independent panel of experts that advises the United States Food and Drug administration (FDA) has voted in favour of recommending a 10-microgram dose of the Pfizer-BioNTech COVID-19 vaccine for children aged 5–11 years. Seventeen of the 18 panel members voted to recommend the vaccine, with one panel member abstaining from voting. The 10-microgram injection is one-third the dose given to adults; this was selected to minimise the risk of adverse effects, yet Pfizer
reports it is still >90% effective in preventing symptomatic COVID-19 infection. If the FDA acts to authorise these recommendations, which is expected, vaccinations could be made available for children in the United States from early November. It is likely that following this decision, provisional approval will be sought in New Zealand for extending the therapeutic indications for the Pfizer COVID-19 vaccine to include children in this age group. As yet, there is no indication as to the timeline for this process.
We're hiring: Medical Writer position available
An opportunity has arisen for a Medical Writer to join the bpacnz publications team. We are looking for someone with a health
science/science-related tertiary qualification and
a high standard of written English and creative communication skills. Previous experience in medical writing is an advantage but not essential as training will be provided.
If you, or someone you know, fits this description, then click here for further information:
Paper of the Week: A spotlight on AHA scientific sessions: advances in hypertension research
In September, 2021, the American Heart Association (AHA) hosted their annual Hypertension
Scientific Session, where researchers from around the world came together (albeit virtually)
to present and discuss recent scientific advances. Among the various topics covered was preliminary
data from a study examining differences in blood pressure control between adults
depending on their gender and age. These findings suggest that females aged 70 years and older and males aged 20 to 49 years with hypertension are more likely to have uncontrolled
blood pressure despite taking antihypertensive medicines.
- The study presented data from the National Health and Nutrition Examination Surveys (1999–2018), which included
13,253 adults diagnosed with hypertension who were taking an antihypertensive medicine
- The average age of the cohort was 57 years, 52% were female, and 71% were of Caucasian ethnicity. Overall,
34% of people included in this study had uncontrolled hypertension.
- Among adults aged 49 years or younger, males consistently had a higher risk of experiencing
uncontrolled blood pressure than females; the risk was 59% higher in males aged 20–29 years (adjusted odds ratio,
0.41; 95% CI, 0.19–0.87), 70% higher in males aged 30–39 years (adjusted odds ratio, 0.30; 95% CI, 0.21–0.43)
and 47% higher in males aged 40–49 years (adjusted odds ratio, 0.53; 95% CI, 0.39–0.73)
- In adults aged 50–69 years, males and females had a comparable risk of uncontrolled hypertension
- Among adults aged 70 years or older, females had a higher risk of experiencing uncontrolled
blood pressure than males; the risk of uncontrolled blood pressure was 29% higher in females aged 70–79 years
(adjusted odds ratio, 1.29; 95% CI, 1.04–1.59) and 63% higher in females aged 80 years or older (adjusted odds
ratio, 1.63; 95% CI, 1.23–1.49)
- The researchers concluded that “this is in line with literature demonstrating accelerated increase in
blood pressure post-menopause and it really suggests that there is a need to improve blood pressure control
in older women”. Regarding the findings for uncontrolled hypertension in younger males, a cardiologist
attending the symposium stated “It's really a call to action to discuss with men in that age group the
importance of adhering to medications that they're prescribed, but also to address lifestyle changes such as
low sodium diet, adequate exercise, and monitoring of their blood pressures at home”
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