Published: 21st December, 2023
Contents
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:
Top 10 resources overall viewed on www.bpac.org.nz by people in New Zealand
Top 10 resources published by bpacnz in 2023 viewed by people in New Zealand
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: [email protected]
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).
Who is eligible?
People aged 30 years and older, people aged 16 years and older who are pregnant and those aged 12 – 29 years at higher risk of severe illness from COVID-19 are eligible for additional COVID-19 boosters (regardless of the number of boosters previously received).
Additional booster doses are usually given at least six months apart, or six months after a positive COVID-19 test. Clinical discretion, however, can be applied but there should be a minimum of five months between the primary course and first booster, four months between booster doses and a minimum of three months after infection with COVID-19.
Focus on these groups in particular:
The Immunisation Advisory Centre has released updated guidance on who is most likely to benefit from an additional COVID-19 booster dose. This includes people in the following categories, but particularly those with chronic and multiple co-morbidities, or people who are at increased risk of frailty if they become even mildly unwell:
- Aged 65 years and older
- Aged 50 years and older of Māori or Pacific ethnicity
- Living in aged residential care facilities
- Who are pregnant and have not received any booster dose or have no history of COVID-19 (particularly those with co-morbidities and high-risk pregnancies)
- Aged 12 years and older with a medical condition that increases their risk of severe COVID-19 (particularly those with severe immunocompromise who were eligible for a third primary dose)
- Who were recommended to have a booster dose in April, 2023, but have not yet done so
For further information on COVID-19 vaccines, including eligibility criteria for a booster dose, see: https://info.health.nz/immunisations/vaccines-aotearoa/covid-19-vaccines/getting-covid-19-vaccines/ 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.
Key findings
From July, 2022, to July, 2023, 6,799 adults and 2,029 children (aged 0 – 14 years) participated in the survey. The results show that:
- Smoking rates continue to decline; 6.8% of adults were daily smokers, down from 8.6% in the previous year. Over the last ten years, the rate of daily smoking has reduced almost 10%, from 16.4% in 2011/12.
- Vaping/e-cigarette use has increased; 9.7% of adults were daily vapers/e-cigarette users, up from 8.4% in the previous year. Daily vaping is particularly prevalent among people aged 18 – 24 years (25.2%) and Māori (23.5%) and Pacific (18.7%) adults.
- Rates of hazardous drinking are slowly declining; 16.0% of adults were considered hazardous drinkers compared to 18.7% in the previous year. Rates were particularly high among Māori (25.1%) but decreased from the previous year (33.4%). There has also been a slight decline in the overall proportion of people who had consumed alcohol in the past year.
- One in eight (11.9%) adults experienced high or very high levels of psychological distress. This rate was highest among young adults; approximately one in five (21.2%) people aged 15 to 24 years. Young adults also reported the highest level of unmet need for mental health support. More adults with a disability reported high to very high levels of psychological distress (35.9%), compared to adults without a disability (9.5%).
- One in five (21.3%) children lived in households where food ran out sometimes or often (up from 14.4% in the previous year), and this was more common in children of Māori (35.1%) and Pacific (39.6%) ethnicity
- Fewer than half of adults (46.5%) met weekly physical activity guidelines. One in three adults were obese (similar to the previous year).
- Approximately one-third of adults and children did not brush their teeth with fluoride toothpaste at least twice per day. Nearly half of adults (44%) had unmet need for dental care due to cost.
- Time taken to get an appointment continues to be the most common reason for not seeing a general practitioner, with one in five adults (21.2%) citing this as a barrier, up from one in ten (11.6%) in the previous year. There was a slight decrease in the number of adults who visited a general practitioner (73.2%), compared to the previous year (75.2%).
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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