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Published: 29 October, 2021


New article: Lung cancer follow-up and surveillance: the role of primary care

In the second article 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 available here.

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 death; and
  • 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.

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

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.

This Bulletin is supported by the South Link Education Trust

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