single PDF of the entire issue - The Royal New Zealand College of ...

More documents

Recommendations

Info

continuing professional development VAIKOLOA The challenges we face across the entire social and economic spectrum continue to grow. Pacific peoples are disproportionately represented in the lower socioeconomic strata, and this is significant because of our experiences with poor health outcomes. Health inequalities exist in sociallydisadvantaged groups due to poorer health, a greater exposure to health hazards across the whole life course, and limited access to highquality health services than other more privileged population groups. Nowhere is this more obvious than amongst Pacific children, who have a higher prevalence of obesity compared with the total population, and the prevalence nearly doubles between the age groups of two to four years and five to nine years. All of us who work in the health sector should be aware of the serious challenges we face as we navigate and chart our course for the next three to five years, in light of: …services for Pacific peoples need to be particularly adaptable and innovative to respond to Pacific peoples’ varied needs and preferences. rest of the world. May you also grow in knowledge, wisdom, and empathy for Pacific peoples, their health and wellbeing, as you receive of our koloa—Vaikoloa. Vinaka vakalevu. References 1. Callister P, Didham R. Emerging demographic and socioeconomic features of the Pacific population in New Zealand. In: Bisley A, editor. Pacific interactions: Pasifika in New Zealand, New Zealand in Pasifika. Wellington: Institute of Social Studies; 2008. 2. Blakely T, Tobias M, et al. Tracking disparity: trends in ethnic and socioeconomic inequalities in mortality, 1981–2004. Wellington: Ministry of Health; 2007. 3. Blakely T, Richardson K, et al. Does mortality vary between Pacific groups in New Zealand Estimating Samoan, Cook Island Maori, Tongan, and Niuean mortality rates using hierarchical Bayesian modelling. N Z Med J. 2009;122(1307):18–29. 4. McCool J, Woodward A, Percival T. Health of Pacific Islanders: achievements and challenges. Asia Pac J Public Health. 2011;23(1):7–9. 5. Minister of Health and Minister of Pacific Island Affairs. ‘Ala M’oui: Pathways to Pacific health and wellbeing 2010–2014. Wellington: Ministry of Health; 2010. 6. Ministry of Health. Improving quality of care for Pacific Peoples. Wellington: Ministry of Health; 2008. 7. Ministry of Health. A focus on the health of Maori and Pacific children: Key findings of the 2006/07 New Zealand Health Survey. Wellington: Ministry of Health; 2009. 8. Ministry of Health. Pacific Health. Message from the Clinical Director Pacific Health. January 2011. • the economic difficulties many of our communities and providers find themselves in • the emerging health issues coupled with the changing demographics of our communities • the challenges of implementing Whanau Ora alongside our Pacific models of care. 6–8 I believe these challenges will strengthen our resolve to work together, pool our resources, and share our koloa for the improved health and wellbeing of our people. I am committed to working with all health providers to reinforce their service delivery models of health care so they remain responsive to the health needs of Pacific peoples for the future. I am also committed to the Ministry of Health’s ‘Ala Mo’ui as it represents a significant milestone for enabling Pacific peoples to improve their educational opportunities as well as their living and working conditions, over the next five years. May Vaikoloa refocus our commitment to each other and enrich our families and relationships as we share and exchange koloa in NZ and beyond to the Pacific Islands and the 168 VOLUME 3 • NUMBER 2 • JUNE 2011 J OURNAL OF PRIMARY HEALTH CARE
continuing professional development NUGGETS OF KNOWLEDGE NSAIDs and risk mitigation —if you really must use them in the elderly Linda Bryant MClinPharm, PGDipHospPharmAdmin, PhD, FNZHPA, FNZCP, FPSNZ, MCAPA If you have balanced the risks and benefits of using a NSAID in an older person, then the following points are some risk mitigation strategies. • Prescribe low dosages e.g. naproxen 250 mg up to bd, or diclofenac 25 mg bd –– For general inflammation/pain ‘half doses’ are usually adequate. High doses are mainly required for rheumatoid arthritis –– You do not need to prescribe the slow release forms, which generally mean higher dosages. • Renal adverse effects –– Renal adverse effects are dose-related –– Check baseline renal function and repeat in one to two weeks, then one to three monthly depending on the baseline renal function –– Try to avoid the ‘triple whammy’—a diuretic and ACE inhibitor or an angiotensin II antagonist, plus an NSAID –– Warn the person not to become dehydrated. Keep fluid intake up to at least 1500 mL per day. • Gastrointestinal adverse effects –– Gastrointestinal effects are dose-related –– The risk is about 1%/patient/year (a relative risk of four to seven, i.e four to seven times the risk of a GI bleed) –– For high-risk people prescribe a proton pump inhibitor –– High risk people are people with at least two of the following criteria: • Over 65 years old • Previous peptic ulcer disease • On a second NSAID (including aspirin) • On warfarin or other antithrombotic medicine. This includes SSRIs and tramadol (antiplatelet effects). The effect of these medicines may be very small when used alone, but is cumulative with NSAIDs • On prednisone –– There is poor correlation between dyspepsia and the risk of a gastrointestinal bleed (i.e. GI bleeds are usually asymptomatic in that pain does not often precede the bleed) –– Warn patients to be observant for black stools and report this to their GP immediately. • Cardiovascular adverse effects –– Increased risk of a cardiovascular event • Naproxen at 1000 mg daily is considered the NSAID with the least cardiovascular risk • High doses of diclofenac (150 mg daily) is associated with an increased cardiovascular risk –– Heart failure • The relative risk for de novo heart failure is approximately 1.6 (i.e. 1.6 times greater risk) • The relative risk for an exacerbation of heart failure is approximately 26 (i.e. 26 times the risk) –– Blood pressure • On average an NSAID may increase blood pressure 5 mmHg—a clinically significant increase • Monitor patients monthly for three months. • Other –– NSAIDs have a number of other adverse effects that are a risk for all people. These include common adverse effects such as: • Headache, rash, dizziness, vertigo, gastric upset, raised transaminases • Beware of exacerbations of asthma in older people with nasal polyps. Author’s conclusions: There are times when a NSAID is unavoidable in an older person. When one is necessary start with a low dose, avoid long-acting (high dose) preparations, and monitor gastrointestinal, cardiovascular and renal adverse effects. Record risk mitigation strategies in the person’s medical records. Nuggets of Knowledge provides succinct summaries of pharmaceutical evidence about treatment of common conditions presenting in primary care and possible adverse drug reactions. key points • Improved quality of life is the ultimate goal of medicines therapy. • For some elderly people regular paracetamol is inadequate, an opiate is not suitable/ not tolerated and a NSAID is necessary to provide good pain relief, increase mobility, maintain independence, improve mood and generally improve quality of life. • If a NSAID is necessary for an older person then management of the potential adverse effects is essential. CORRESPONDENCE TO: Linda Bryant Clinical Manager, Clinical Advisory Pharmacist, East Health Trust PHO PO Box 38248, Howick Auckland, New Zealand l.bryant@auckland.ac.nz VOLUME 3 • NUMBER 1 • MARCH 2011 J OURNAL OF PRIMARY HEALTH CARE 169
Page 1:
VOLUME 3 • NUMBER 2 • JUNE 2011
Page 4 and 5:
EDITORIALs from the editor Morality
Page 6 and 7:
EDITORIALs guest editorial The youn
Page 8 and 9:
ORIGINAL SCIENTIFIC PAPERS quantita
Page 10 and 11:
Page 12 and 13:
Page 14 and 15:
Page 16 and 17:
ORIGINAL SCIENTIFIC PAPErS quantita
Page 18 and 19:
Page 20 and 21:
Page 22 and 23:
Page 24 and 25:
Page 26 and 27:
Page 28 and 29:
Page 30 and 31:
Page 32 and 33: ORIGINAL SCIENTIFIC PAPErS quantita
Page 38 and 39: ORIGINAL SCIENTIFIC PAPERS quaLitat
Page 56 and 57: ORIGINAL SCIENTIFIC PAPERS MIXED ME
Page 64 and 65: improving performance (Preventing)
Page 66 and 67: improving performance ACKNOWLEDGEME
Page 68 and 69: improving performance All practices
Page 70 and 71: improving performance 5. Wrong pati
Page 72 and 73: improving performance errors that o
Page 74 and 75: BACK TO BACK shaking would cause ne
Page 76 and 77: BACK TO BACK The triad of retinal h
Page 78 and 79: continuing professional development
Page 80 and 81: continuing professional development
Page 84 and 85: ETHICS Medical ethics: four princip
Page 86 and 87: ETHICS of his responsibility to ACC
Page 88 and 89: ETHICS ing a case against Dr G’s
Page 90: about the journal of primary health
show all

single PDF of the entire issue - The Royal New Zealand College of ...

Create successful ePaper yourself

Delete template?

Save as template?