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Issue 46 September 2012

Best Practice Journal
Acute-on-chronic kidney disease: prevention, diagnosis, management and referral in primary care Acute kidney injury (in a community setting) occurs most commonly in people with existing chronic kidney disease. The first focus of primary care is to prevent acute-on-chronic kidney disease from occurring. However, preventative strategies cannot remove the risk completely. Acute kidney injury should be considered a medical emergency. If there is a clearly identifiable cause then this should be managed. If the cause of deterioration is not clear then this warrants early discussion with nephrology services. View Article
Bronchiolitis in infants Bronchiolitis is the most common lower respiratory tract infection in infants, and between 2006 and 2010 accounted for almost 15% of all childhood illness-related hospital admissions in New Zealand. Bronchiolitis is diagnosed clinically, and children can usually be managed at home, unless symptoms are severe, or risk factors for complications are present, e.g. very young age, co-morbidities, socioeconomic factors. View Article
Bronchiectasis: rates still increasing among Pacific peoples Bronchiectasis is a lung disease characterised by irreversible bronchial dilation and chronic inflammation, resulting in chronic wet cough. It occurs in both children and adults, and although a relatively uncommon condition, bronchiectasis disproportionately affects Māori and Pacific peoples and people from lower socioeconomic communities. View Article
Otitis media: a common childhood illness It has been suggested that otitis media is an unavoidable illness of childhood. In most cases, symptomatic treatment is all that is required, however, in severe cases, complications can occur, such as perforation of the tympanic membrane, otitis externa, mastoiditis and disturbances to balance, motor control and hearing. Children living in lower decile communities, where overcrowding is common, are at increased risk of developing otitis media and complications. View Article
A delicate balance: managing vertigo in general practice Vertigo is a symptom, not a diagnosis. Although usually benign, vertigo can be a symptom of a significant underlying problem. Differentiating between the simple and the serious causes is a challenging process of elimination, based on the patient's description of their symptoms and the interpretation of signs found on examination. View Article
Assessing cardiovascular risk in people with high clinical risk factors Cardiovascular risk assessment tools automatically adjust risk to greater than 20% for people with high risk factors, e.g. a prior cardiovascular event or overt diabetic nephropathy. This is leading to a blurring of the concept of primary and secondary prevention and in some cases, patients are not receiving the intensive interventions required as the perception is that their risk is always high and cannot be reduced. People with high clinical risk factors have the most to gain from cardiovascular risk lowering interventions. View Article
Funding changes to diabetes management products announced Key dates for the changes CareSens meters Insulin pumps View Article
Medicines interactions: using the New Zealand Formulary How to interpret Stockley's Interaction Alerts How to use the interactions checker Relative importance of interactions Additional interactions information from the BNF View Article
Correspondence Correspondence for Best Practice Journal Issue 46, September 2012 View Article