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BPJ 65 December 2014

Best Practice Journal

Managing patients who are obese: Encouraging and maintaining healthy weight-loss

A more recent article has been published on this subject: Weight loss: the options and the evidence

The mainstays of obesity management are simple and well known to health professionals: reduce sugar and saturated fat intake, eat more fresh vegetables and whole grain fibre and increase physical activity. The complexity lies in the psychosocial, cultural and economic barriers that people need to overcome in order to sustain the lifestyle changes required to achieve long-term weight-loss. “Fad” diets, myths and misinformation about weight-loss, and the difficulties of discussing obesity with patients, add to this challenge. Patients who do manage to lose weight should be followed-up regularly in primary care to encourage them to maintain their lifestyle changes. Currently no anti-obesity medicines are funded in New Zealand and there is a very limited role for their use in obesity management, although several new medicines have recently been licensed overseas. Bariatric surgery is the most effective and sustainable weight-loss treatment for select patients who are morbidly obese.

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The “supporting weight management in primary care” programme

The Western Bay of Plenty PHO (WBOPPHO), in conjunction with the University of Auckland, has launched a pilot weight management programme for primary care. The programme uses a brief opportunistic approach to make it easier for health professionals to engage with patients with weight- or diet-related health issues. The programme provides health professionals with support material that covers diet, exercise and stress management. The format of the intervention is similar to the “ABC” smoking cessation tool, which is familiar to most primary care clinicians. The three-tiered approach focuses on: Ask, Brief advice and Offer ongoing support or onward referral – “ABO”. If this approach proves successful in the pilot programme, the ABO toolkit will be made available nationally. View Article

Ingrown toenails: digging out the facts

The best method for treating patients with an ingrown toenail has long been debated. Non-surgical options are generally preferred for patients with mild-to-moderate symptoms, and surgical options preferred in patients with more severe symptoms. However, there is limited evidence available regarding the effectiveness of non-surgical treatments. Recent evidence suggests that some surgical techniques are associated with very low recurrence rates of the ingrown toenail, and therefore should be considered more often, despite being a more invasive treatment. View Article

Tinea pedis: not just the curse of the athlete

Tinea pedis is a common fungal foot infection that is often associated with high rates of treatment failure or recurrence. This is often due to inadequate duration of antifungal treatment. In most cases, tinea pedis can be managed with topical antifungal treatment, however, oral antifungal treatment is sometimes required, e.g. in patients with more severe infections, including moccasin tinea pedis, those with fungal nail infections and those with repeated topical treatment failures. View Article

Cracked Heels: stop them in their tracks

Cracked heels are most often caused by a lack of moisture in the skin. Fissures generally occur on the back of the heel and usually affect both feet. For most people cracked heels are a cosmetic problem only, however, fissures can become problematic if they deepen and cause pain, and in some cases infection will develop. Topical products, e.g. urea-based creams, are used to both prevent and treat cracked heels. View Article

Plantar warts: a persistently perplexing problem

Plantar warts, also known as plantar verrucae, are manifestations of infection with human papillomavirus. They can be painful due to their position on weight-bearing skin and in some patients may cause embarrassment due to their cosmetic appearance. Plantar warts often spontaneously resolve so conservative management is an option, particularly as some warts are resistant to multiple treatments. Although cryotherapy using liquid nitrogen is a conventional treatment for warts, there is limited evidence that this is an effective management method. Topical treatments for warts have variable success rates, however, wart paints and gels containing salicylic acid show good evidence of efficacy. Melanoma is a rare but important differential diagnosis. View Article

Melanoma of the foot

Acral melanoma is a subtype of cutaneous melanoma, which manifests on the palms, wrists and soles of the feet (including the nail unit). Melanoma on the soles of the feet may be unnoticed by the patient for many years, and can be misdiagnosed as other podiatric skin conditions, including plantar warts. View Article

Medicine updates

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Upfront: The latest on IPIF

The aim of the Integrated Performance and Incentive Framework (IPIF) is for DHBs, PHOs, general practice teams and other primary care services to work together to plan and provide health services. The framework has been developed by the health sector with support from the Ministry of Health and is currently in a transitional phase. This update contributed by the IPIF team looks at the development of the framework’s system performance measures, with insights from some of the clinicians involved. View Article

Correspondence: Antibiotic guidelines for managing sore throat

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Peer Group Discussion

We look back at the key messages and practice points from selected articles in Best Practice Journals View Article