Issue 33 December 2010 - Contents
Welcome to BPJ 33
Despite much being known about cardiovascular risk assessment, there are still areas which remain contentious or are not supported by conclusive evidence. We invited a group of practitioners, with expertise and interest in cardiovascular disease, to discuss some of these issues. Are current risk assessment tools still relevant? Should additional risk factors be used to calculate cardiovascular risk? Is there any evidence for the use of surrogate risk markers? Who should calcium and vitamin D supplements be used for? Should aspirin be used for primary prevention? Do nuts reduce cardiovascular risk?
Routine screening for thyroid dysfunction is not recommended unless there are symptoms and signs of thyroid disease. If thyroid dysfunction is suspected, TSH is the best initial test and an abnormal result will trigger laboratory reflex testing of additional thyroid function tests as indicated, in most laboratories. Treatment of hypo- or hyperthyroid dysfunction is guided by TSH results and the clinical situation. Levothyroxine is the treatment of choice for hypothyroidism and a thionamide, such as carbimazole, is most often used to treat Graves' hyperthyroidism. Special consideration needs to be taken in the management of women with thyroid dysfunction who are pregnant.
The rate of smoking among New Zealanders is slowly declining, however, more work needs to be done to further reduce this number. Brief advice on smoking cessation from a healthcare professional increases the likelihood that someone who smokes will successfully quit and remain a non-smoker long-term. Health professionals should follow the “ABC” format – ask whether the patient smokes, give brief advice to quit and offer evidence based cessation support.
- Christmas message
- Upfront: Pharmacogenomics for general practitioners: time for clinical application
- Short article: Antimicrobial resistance: where are we now?
- Snippets: Fentanyl patches available without Special Authority in 2011
- Correspondence: Medicine-induced dystonic reactions • Risk of hyponatraemia with antidepressants
- Quiz feedback: CVRA and Managing thyroid dysfunction