GP_Practice_Review_Issue_5

GP

In this issue:

Updated type 2 diabetes guidelines from the NZSSD

Aspirin with or without statins for primary prevention of cardiovascular disease across risk categories

TSANZ position statement on chronic suppurative lung disease and bronchiectasis

FDA updates mammography regulations on reporting of breast density

Global Strategy for Asthma

Management and Prevention: updated guidelines

American College of Cardiology expert consensus decision pathway on management of heart failure with preserved ejection fraction

Comparison of popular dietary programmes in patients at increased cardiovascular risk

Hypertension in pregnancy: updated guidance from NICE Pharmac listings and consultations

CARM adverse reaction case reports

Australian College of GPs backs vaping crackdown

Abbreviations used in this issue

ACC = American College of Cardiology

ACE = angiotensin-converting enzyme

ADHD = attention-deficit hyperactivity disorder

AF = atrial fibrillation

ARB = angiotensin II receptor blockers

ASCVD = atherosclerotic cardiovascular disease

BP = blood pressure

CARM = Centre for Adverse Reactions Monitoring

CGM = continuous glucose monitoring

CSLD = chronic suppurative lung disease

CV = cardiovascular

CVD = cardiovascular disease

FBC = full blood count

GDMT = guideline-directed medical therapy

GLP-1R = glucagon-like peptide 1

HF = heart failure

HFpEF = heart failure with preserved ejection fraction

Practice Review

Welcome to the fifth issue of GP Practice Review.

This Review covers news and issues relevant to general practice. It will bring you the latest updates, both locally and from around the globe, on topics such as new and updated treatment guidelines, changes to medicines reimbursement and licensing, educational, professional body news and more. And finally, on the back cover you will find our COVID-19 resources as well as a summary of upcoming educational opportunities. We hope you enjoy this GP Practice Review publication and look forward to hearing your comments and feedback. Kind regards, Dr Bryan Betty admin@researchreview.co.nz

P.S. We wish to correct an error from issue number 4 where the PCSK9 inhibitor alirocumab was reported as not being available in New Zealand, however alirocumab (Praluent®) is Medsafe-approved, and patients can choose to self-fund.

Clinical Practice

Updated type 2 diabetes guidelines from the NZSSD

The New Zealand Society for the Study of Diabetes (NZSDD) has published updated guidance on the management of T2D. In the new algorithm, lifestyle management and metformin remain the first-line interventions and the recent shift towards reducing CV and renal risk and obesity are emphasised, in addition to improving glycaemic control. Specific changes to the updated guidance include:

Changes in lifestyle management

• A new emphasis on individualised weight management plans aiming for 10-15% weight loss in early disease to achieve T2D remission

• The emphasis on patient education and support to facilitate self-management has increased

• New section on healthy sleep to improve glycaemic control and weight loss

• Cancer screening and influenza vaccination should be included in wrap-around care

Changes for glucose-lowering medicines

The aim of this section was to recognise ‘off-label’ prescribing given the delay in updating data sheets.

• Metformin dosing does not need to be reduced unless the patient’s eGFR <45 mL/min

• Empagliflozin and/or dulaglutide or liraglutide should be considered in patients aged 10-17 years based on safety and efficacy data*

• Empagliflozin can now be initiated in patients with eGFR >20 mL/min*

• Multiple weekly dulaglutide injections may be considered if the patient is tolerating treatment and has not reached their HbA1c target – the maximum dose is 4.5 mg per week*

• Vildagliptin is redundant if a GLP-1R agonist is introduced and should be withdrawn

• Sulfonylureas and/or insulin can be reduced or withdrawn, where appropriate, when newer agents are introduced

• Liraglutide (Victoza®) is now available under the same Special Authority as dulaglutide – prescribe funded Novofine® or BD® 4 or 5-mm needles

o There is no evidence that either dulaglutide or liraglutide is superior in terms of glycaemic control

o Liraglutide may be preferable if T2D patients cannot obtain or are intolerant to dulaglutide or prefer daily injections Management of hypoglycaemia

• Hypoglycaemia management in T2D has been simplified to prevent both under and over-treatment

o If body weight ≥70 kg take 30 g of rapid acting carbohydrate OR

o If body weight <70 kg take 15 g of rapid acting carbohydrate, repeat after 15 minutes if glucose levels <4 mmol/L Other changes

• The target LDL has been lowered from 1.8 mmol/L to < 1.4 mmol/L

• Lipid-lowering therapy is important to reduce microvascular complications – rosuvastatin is available if LDL cholesterol is above target

• Endorsement of all licenses for Waka Kotahi can now be performed by medical practitioners and diabetes nurse specialists

o Continuous glucose monitoring has been included with targets

o Sulfonylureas are useful for steroid-induced hyperglycaemia

• Acarbose should be taken with meals

ICS-SABA = inhaled corticosteroid short-acting beta-agonist

LVEF = left ventricular ejection fraction

MI = myocardial infarction

NZSDD = New Zealand Society for the Study of Diabetes

RACGP = Royal Australian College of General Practitioners

RCT = randomised controlled trial

RR = relative risk

SGLT2 = sodium-glucose cotransporter-2

T2D = type 2 diabetes

*Recommendation is unapproved and prescribing in this way is ‘off-label’ Read more here

This Research Review has been endorsed by The Royal New Zealand College of General Practitioners (RNZCGP) and has been approved for up to 1 CME credit for the General Practice Educational Programme (GPEP) and Continuing Professional Development (CPD) purposes. You can record your CME credits in your RNZCGP Dashboard

Aspirin with or without statins for primary prevention of cardiovascular disease across risk categories

The use of aspirin for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) is controversial and most randomised controlled trial (RCT) evidence favouring its use was conducted before statins were recommended to prevent ACSVD. A meta-analysis was therefore conducted to examine the effect of aspirin in adults without ASCVD, stratified across differing CV risks and according to statin use. RCTs were included of aspirin in patients without ASCVD with followup ≥1 year. The investigators used random-effects models to estimate relative and absolute 5-year risks for CV outcomes, major bleeding, and mortality.

The analysis included 16 trials (n=171,215) reporting on MI and 12 trials (n=163,578) reporting on major bleeding. Aspirin was associated with lower rates of MI (RR 0.85, 95% CI 0.77-0.95; p<0.001) but a higher risk of major bleeding (1.48,1.32-1.66; p<0.001), compared with control. Aspirin was not associated with a reduced risk of stroke or mortality. It was calculated that for every 10,000 adult patients, aspirin reduced MI by 3 events as monotherapy and by 1 event with a statin for very low ASCVD risk patients and reduced events by 49 as monotherapy and by 37 events with a statin for very high risk patients. For major bleeding in every 10,000 patients, aspirin increased the number of events by 21 as monotherapy and by 20 with statins for very low ASCVD risk and by 98 events as monotherapy and by 94 events with a statin for very high risk.

The investigators concluded that in patients without ASCVD, the risk of major bleeding associated with aspirin is greater than the reduction in MI risk across all ASCVD risk levels. Concurrent use of a statin reduces the cardiovascular benefits of aspirin without influencing bleeding risk. Therefore, in patients without ASCVD who are already taking a statin, the addition of aspirin is unlikely to achieve a meaningful CV benefit but would increase the risk of major bleeding.

Independent Content: The selection of articles and writing of summaries and commentary in this publication is completely independent of the advertisers/ sponsors and their products. Privacy Policy: Research Review will record your email details on a secure database and will not release them to anyone without your prior approval. Research Review and you have the right to inspect, update or delete your details at any time. Disclaimer: This publication is not intended as a replacement for regular medical education but to assist in the process. The reviews are a summarised interpretation of the published study and reflect the opinion of the writer rather than those of the research group or scientific journal. It is suggested readers review the full trial data before forming a final conclusion on its merits. Research Review publications are intended for New Zealand health professionals.

Practice Reviews cover news and issues relevant to New Zealand clinical practice. Research Review Ltd is an independent publisher. Research Review receives funding from a variety of sources including Government departments and agencies, pharmaceutical companies, insurers and other organisations with an interest in health. Journal content is created independently of advertisers with assistance from leading local specialists. Publications are free to receive for health care professionals, to subscribe go to www.researchreview.co.nz

Thoracic Society of Australia and New Zealand (TSANZ) position statement on chronic suppurative lung disease and bronchiectasis

This position statement from TSANZ updates 2015 guidelines for managing children, adolescents and adults with chronic suppurative lung disease (CSLD) and bronchiectasis. CSLD and bronchiectasis are characterised by a recurrent or long-term productive or wet cough, and infections of the lower airways. In patients with bronchiectasis, bronchial dilation secondary to structural airway injury is present on radiography. The position statement emphasises the importance of early diagnosis for CSLD and bronchiectasis, particularly as early bronchiectasis in young people is now recognised as being potentially reversible. Additional points from the position statement include:

• A diagnosis of bronchiectasis should be confirmed with a chest CT scan, using age-appropriate protocols and criteria in children

• A baseline panel of investigations should be undertaken, which in children and adolescents should include: FBC, major immunoglobulin classes (G,A,M,E), sweat test for chloride testing, culturing airway secretions and spirometry where age appropriate (usually aged >6 years)

• Baseline severity should be assessed along with health impact and individualised management plans developed using a multi-disciplinary approach and co-ordinated care between providers

• Intensive treatment is recommended to improve symptom control, reduce the frequency of exacerbations, maintain lung function, maximise QoL and extend survival. In children, a goal of care is to optimise lung growth and, if possible, reverse bronchiectasis.

• Patients should be taught individualised airway clearance techniques by a respiratory physiotherapist and encouraged to exercise, optimise their nutrition, avoid air pollutants and ensure vaccinations are up to date

• Exacerbations should be treated with a 14-day course of antibiotics as guided by lower airway culture, local susceptibility, clinical severity and patient tolerance. Hospitalisation is recommended for patients with severe exacerbations or those who are not responding to therapy.

• Pseudomonas aeruginosa should be eradicated if it is detected in lower airway cultures

• Treatment with long-term antibiotics, ICS, bronchodilators and mucoactive therapies should be individualised

• Patients should be monitored every 6 months for complications and comorbidities

The concept of ‘treatable traits’ is also highlighted in the position statement whereby clinicians are encouraged to address the individual pulmonary, aetiological, extra-pulmonary, and environmental/lifestyle aspects of each disorder.

Respirology 2023 Apr;28(4):339-349

FDA updates mammography regulations on reporting of breast density

The U.S. FDA updated its mammography regulations on 9 March 2023. Within 18 months, mammography facilities will be required to notify patients about the density of their breasts to improve physician assessment and categorisation of mammograms.

Dense breasts are a risk factor for developing breast cancer and can also make it more difficult to detect breast cancer on mammograms. In the United States, approximately half of women aged >40 years are described as having dense breast tissue on mammogram. The FDA believes the updated regulations will ensure that patients receive important information that could influence their decision making, such as the need to undergo further evaluation or a repeat mammogram or to increase the frequency of surveillance.

The FDA recommends that patients assessed as having dense breasts talk to their healthcare provider about breast density, risks factors for breast cancer and their individual situation. In New Zealand, patients who undergo mammograms are only told about their breast density if they undertake a private mammogram. Mammograms continue to be recommended as the preferred method of screening for breast cancer and the early detection of the disease.

Read more here

References: 1.

PHARMAC Online

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the spasm, relieve the pain.

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Global Strategy for Asthma Management and Prevention: updated guidelines

The Global Initiative for Asthma (GINA) published updated guidance on the prevention and management of asthma in May, 2023. The key changes from the 2022 GINA report are:

1. Clarification of asthma medication terminology. For example, the term ‘controller’ has been replaced where appropriate by ‘maintenance treatment’ and use of the term ‘anti-inflammatory reliever’ has been clarified.

2. New commentary has been added to help clinicians explain the asthma management cycle to patients.

3. As-needed combinations of ICS-SABA have been added to the alternative (Track 2) treatment algorithm for adults and adolescents aged >12 years.

4. As needed ICS-formoterol is still the preferred maintenance treatment and reliever for adults and adolescents aged >12 years, despite the addition of ICS-SABA to Track 2 of the algorithm.

5. Practical guidance has been included on dosing medications.

6. The anti-interleukin-5 antibody mepolizumab has been included in the preferred treatment options for children with severe eosinophilic asthma at Step 5.

7. For the sake of clarity, it is explicitly stated that there is insufficient evidence for maintenance treatment at Step 1 in children aged ≤5 years.

8. The use of the term ‘mild’ asthma has been further refined due to differences in common usage and academic definitions. This topic is an ongoing discussion for GINA.

9. GINA recommends biologic therapy only for patients with severe asthma and only if existing treatments have been optimised. This recommendation is regardless of local regulatory approvals.

10. Further details have been provided regarding dosing ICS-formoterol and ICS-SABA during asthma exacerbations. This information has been included in downloadable action plans.

The diagnosis of asthma continues to be an area of interest and discussion for GINA. Recent guidelines have recommended FeNO testing in preference to bronchodilator responsiveness for patients whose lung function pre-bronchodilation is above specified criteria. This recommendation is currently problematic for several reasons, not least that two days of testing would be required given that FeNO must be performed prior to spirometry. GINA has not changed its guidance for diagnostic testing for 2023.

Read more here

2023 American College of Cardiology (ACC) expert consensus decision pathway on management of heart failure with preserved ejection fraction

Heart failure with preserved ejection fraction (HFpEF) is defined as LVEF ≥50% in combination with signs and symptoms of HF. To estimate the probability of a patient having HFpEF, one of two scoring systems may be used. The H2FPEF (Heavy, 2 or more Hypertensive drugs, atrial Fibrillation, Pulmonary hypertension, Elder age > 60, elevated Filling pressures) algorithm includes hypertension, BMI >30 kg/m2, AF, pulmonary hypertension, age >60 years, and elevated filling pressures, with a score ≥6 being highly suggestive of HFpEF. The HFA-PEFF (Heart Failure Association Pre-test assessment, Echocardiography & natriuretic peptide, Functional testing, Final etiology) algorithm is more complex and comprises pre-test assessment of HF, echocardiography and natriuretic peptide score, functional testing including diastolic stress test/right heart catheterisation, and specialised investigations.

Natriuretic peptides tend to be lower in people who are obese with HFpEF and a high level of suspicion is recommended in obese patients presenting with dyspnoea. Women with HFpEF tend to have worse dyspnoea and reduced health status. Due to concentric remodelling on echocardiogram with greater diastolic stiffness, reduced LV size, and greater LVEF compared to men, an EF of 50-55% in women may be abnormal.

The differential diagnosis of HFpEF may include consideration of non-cardiac causes including renal disease, cirrhosis, and chronic venous insufficiency. Potential cardiac causes that may mimic HFpEF include infiltrative cardiomyopathy, hypertrophic cardiomyopathy, amyloidosis, valvular heart disease, or pericardial disease.

Effectively treating comorbidities is central to the management of HFpEF, including hypertension (systolic BP <130 mmHg), obesity, diabetes, AF, and sleep apnoea. Guidance-directed medical therapy (GDMT) is essential to improve symptoms and functional capacity and to reduce the morbidity and mortality associated with HF. The recommended GDMTs include SGLT2 inhibitors (dapagliflozin*, empagliflozin*), aldosterone antagonists (spironolactone), ARNIs (sacubitril/valsartan†) or ARBs (candesartan). Beta-blockers should be considered for rate control in patients with a history of MI or AF. Diuretics should be used judiciously to reduce congestion and improve symptoms, as needed.

Monitoring pulmonary artery pressure with CardioMEMS™ reduces the risk of hospitalisation for patients with HFpEF. This strategy may not be useful for patients with recurrent hospitalisations or those experiencing changes in volume status.

*Not funded in New Zealand for HF; † Not indicated for HFpEF in New Zealand.

J Am Coll Cardiol. 2023 May;81(18):1835-78

Comparison of popular dietary programmes and the risk of mortality and cardiovascular events in patients at increased risk

The objective of this network meta-analysis was to determine the relative efficacy of structured diet and health behaviour programmes for the prevention of major CV events and mortality in patients with an increased risk of CVD. Randomised trials were included that compared dietary programmes with minimal intervention, e.g. a healthy diet brochure, or alternative programmes with ≥9 months of follow-up. Dietary programmes were able to include exercise, behavioural support, and antiobesity medications. The outcomes measured were all-cause mortality, CV mortality, and individual CV events.

The study included 40 trials with 35,548 patients across seven named dietary programmes (low fat 18 studies, Mediterranean 12, very low fat 6, modified fat 4, combined low fat and low sodium 3, Ornish 3 and Pritikin 1). There was moderate certainty evidence that Mediterranean diets were superior to minimal intervention for preventing all-cause mortality (OR 0.72, 95% CI 0.56-0.92; 17 fewer per 1000 patients following for 5 years), CV mortality (0.55, 0.39-0.78; 13 fewer per 1000), stroke (0.65, 0.46-0.93; 7 fewer per 1000), and non-fatal MI (0.48, 0.36-0.65; 17 fewer per 1000). Also with moderate certainty evidence, low fat programmes were superior to minimal intervention for preventing all-cause mortality (0.84, 0.74-0.95; 9 fewer per 1000) and non-fatal MI (0.77, 0.61-0.96; 7 fewer per 1000). The patients with the highest CV risk gained the greatest absolute benefits. There were no convincing differences between the low fat and Mediterranean diet in terms of mortality or non-fatal MI. The other five dietary programmes that were assessed were generally found to have little or no benefit compared with minimal intervention.

It was concluded that in patients with increased CV risk, Mediterranean and low-fat diets, with or without exercise or other interventions, reduce all-cause mortality and non-fatal MI. Mediterranean diets are also likely to reduce stroke risk.

BMJ 2023;380:e072003

Hypertension in pregnancy: updated guidance from NICE

This updated guideline covers the diagnosis and management of hypertension (including pre-eclampsia) during pregnancy, labour and birth. Guidance is also provided to women with hypertension who wish to conceive and women who have experienced a pregnancy that was complicated by hypertension.

Proteinuria in pregnant women should be considered in the context of a full clinical review for pre-eclampsia. If ≥1 urine dipstick test is positive for proteinuria, the albumin:creatinine ratio or protein:creatinine ratio should be used to quantify the proteinuria. First morning voids should not be used to quantify proteinuria.

Women who are taking ACE inhibitors, ARBs or thiazide-like diuretics should be advised that there is a risk of congenital abnormalities if these medicines are taken during pregnancy. An alternative treatment should be discussed with women with hypertension or renal disease. ACE inhibitors or ARBs should be stopped, preferably within 2 days of pregnancy notification. Educate women with hypertension who are breastfeeding that antihypertensives can pass into breast milk, but this would only lead to the baby receiving very low levels that would be unlikely to have a clinical effect. Most medicines are not tested on breastfeeding patients, therefore the disclaimers in the manufacturer’s information are not due to safety concerns or evidence of harm. Enalapril may be preferentially offered as an antihypertensive during the postnatal period, with appropriate monitoring of maternal renal function and serum potassium.

Women who have experienced a hypertensive disorder during pregnancy (including pre-eclampsia) have an approximate 1 in 5 chance of experiencing a recurrence in future pregnancies. Read more here

New Zealand Research Review subscribers can claim CPD/CME points for time spent reading our reviews from a wide range of local medical and nursing colleges. Find out more on our CPD page.

Regulatory and Funding News

COVID-19 booster eligibility

From 1 May 2023, every person aged ≥30 years is eligible for additional booster doses of COVID-19 vaccine from 6 months after their last COVID-19 vaccination or infection. The bivalent vaccine Comirnaty 15/15 mcg will be used.

Read more here

Supply issue for hydroxocobalamin injections

Pharmac have advised of a supply issue of PanPharma hydroxocobalamin (B12) injections (1 mg/mL). Pharmac have listed another hydroxocobalamin injection (Cobalin H) from 1 May 2023. Stock of alternative products are expected to be available from the middle of May 2023.

Read more here

Phenobarbitone brand-change

The funded brand of phenobarbitone tablets (15 mg and 30 mg) will change because API who is the current supplier of the funded ‘PSM’ brand of phenobarbitone tablets has closed its New Zealand manufacturing operation. Current stocks of phenobarbitone tablets are expected to last until July 2023. A new supplier has applied to Medsafe for marketing approval of phenobarbitone tablets and this application is being assessed.

Read more here

Amended funding rules for dispensing ADHD medicines

The Pharmaceutical Schedule will be amended from 1 June 2023, to make funding rules for ADHD consistent with recent law changes that enable controlled drugs to be prescribed for a maximum of three-months supply.

Read more here

Proposal for pulmonary arterial hypertension treatments

Pharmac are requesting feedback on the way pulmonary arterial hypertension treatments are funded. The treatments which are currently assessed via a panel process are: ambrisentan (Ambrisentan Viatris, Ambrisentan Mylan), iloprost (Vebulis) and epoprostenol (Veletri). Sildenafil (Vedafil) and bosentan (Bosentan Dr Reddy’s) are funded via standard Special Authority applications. Pharmac anticipates that consolidating treatment funding via Special Authority would be easier and more streamlined. Consultation closed on Wednesday, 17 May 2023.

Read more here

Decision to fund the bowel cleansing preparation Plenvu

Pharmac will be funding Plenvu as an alternative bowel cleansing formulation in hospitals. The supplier of Klean Prep has advised that this product has been discontinued globally and supplies in New Zealand are expected to last until August 2023. Plenvu (macrogol 3350 with sodium sulfate, sodium chloride, potassium chloride, sodium ascorbate and ascorbic acid powder) will be listed with other bowel cleansing preparations from 1 May 2023.

Read more here

Topiramate use in pregnancy: further restrictions for safety

A large observational study has linked the use of topiramate by pregnant women with neurodevelopmental disorders and birth defects. Janssen-Cilag is updating the Topamax data sheet regarding this safety update.

Read more here

News in Brief

WHO decides COVID-19 is no longer a global health emergency

The WHO decided on 5 May 2023 that the COVID-19 pandemic no longer constitutes a public health emergency of international concern and should now be considered an ongoing health issue. The WHO recommended that COVID-19 vaccinations be integrated into life course vaccination programmes. To date, 13.3 billion doses of COVID-19 vaccines have been administered worldwide.

Read more here

WHO decides monkeypox is no longer a global health emergency

The WHO decided on 11 May 2023 that the Multi-Country Outbreak of mpox (monkeypox) would be managed via longterm strategies to reduce public health risks, rather than emergency measures due to it being a public health emergency of international concern.

Read more here

New Medical Director of RNZCGP announced

Dr Luke Bradford has been appointed as the new Medical Director of the Royal New Zealand College of General Practitioners. Dr Bradford trained in the United Kingdom and moved to New Zealand in 2008. He has worked in emergency medicine and as a general practitioner in New Zealand.

Read more here

CARM adverse reaction case reports

The Centre for Adverse Reactions Monitoring (CARM) has published a selection of recent and informative cases from their database including reported reactions to bupropion + naltrexone, ivermectin, atenolol, venlafaxine and rizatriptan, and azithromycin.

Read more here

Australian College of General Practitioners backs vaping crackdown

The Royal Australian College of General Practitioners (RACGP) supports the Australian Government’s ‘crackdown’ on vaping and welcomed the commitment to make it easier for people to vape if they have a prescription. The College’s President said it was important to limit the number of young people, including children, who were starting nicotine vaping.

Read more here

Medsafe provides patient information on withdrawing antidepressants

Medsafe has produced a patient information leaflet on withdrawing from antidepressant treatment. The document covers what adverse effects to expect and how they can be managed.

Read more here

COVID-19 Resources

Ministry of Health – Manatū Hauora

IMAC

RNZCGP

COVID-19 antivirals access criteria assessment tool bpacnz

Goodfellow Unit 2023

Events and webinars

Applying polyvagal principles in practice Tuesday, 23 May 2023

Sexuality and intimacy workshop Thursday, 29 June 2023

Travel medicine (with a focus on high altitude travel) Tuesday, 04 July 2023

RNZCGP Endorsed CPD Modules

Paediatric Analgesia – E-Learning Module for GPs

Heavy Menstrual Bleeding – E-Learning Module for GPs

Countering Vaccine Misinformation – E-Learning Module for GPs

Simplifying Asthma Management – E-Learning Module for GPs

Eliminating Hepatitis C – E-Learning Module for GPs

College of Nurses Endorsed CPD Modules

Paediatric Analgesia – E-Learning Module for Nurses, Nurse Practitioners and Nurse Prescribers

Countering Vaccine Misinformation – E-Learning Module for Nurses, Nurse Practitioners and Nurse Prescribers

Heavy Menstrual Bleeding – E-Learning Module for Nurses, Nurse Practitioners and Nurse Prescribers

Eliminating Hepatitis C – E-Learning Module for Nurses, Nurse Practitioners and Nurse Prescribers

Conferences and Workshops

Rotorua GP CME 2023 8-11 June

South GP CME 2023 10-13 August, Christchurch

IMAC courses and events

College of Nurses Aotearoa NZ events

Recent Research Review publications

GP Research Review with Associate Professor Jim Reid and Dr Chris Tofield

Product Review - Mepolizumab (NUCALA) for the treatment of chronic rhinosinusitis with nasal polyps

Speaker Series - COPD management in New Zealand: A survey of real-world GP prescribing

Educational Series - Diabetes management during Ramadan

Speaker series - Differing perceptions of asthma control and personalising treatment to bridge the gap

Educational Series - 2023 update on long-acting reversible contraceptives

Speaker Series - Notes from a spirometry workshop

Product Review - Dymista for allergic rhinitis

Educational Series - Primary care guidance for Sacubitril/valsartan in treatment of heart failure

Educational Series - Pancreatic enzyme replacement therapy (PERT) for PEI

Educational Series - Non-antibiotic interventions for the prevention of recurrent UTIs

Educational series - Herpes zoster in immunocompromised adults

Speaker Series - Navigating mental health and weight management today: A psychiatrist’s perspective