Clinical Matters Newsletter - April 2021 21 Apr 2021

Welcome to the April Edition of Clinical Matters!

In this issue...

New Respiratory Physician at Tauranga Hospital - Meet Dr Johnnie Walker

A big welcome to Johnnie Walker (yes, that's his real name!) who graduated from St. Bartholomew's Medical College in London and has just recently started work at Tauranga Hospital. Here's a message from Johnnie:

"I have been a UK based consultant in acute and respiratory medicine since 2012 and, seeking a better family life, we decided to move to New Zealand.
It is therefore ironic that I arrived here in March, alone, and with my family still in the UK. The pandemic had a major impact on our plans, but my wife and two girls, aged 8 and 10, are all hoping to come to Tauranga in the next few months. At the moment, interests include exploring everything New Zealand has to offer, in my car and on my mountain bike.

Professionally, my specialty interest is in the area of difficult asthma, and prior to coming here I ran the difficult asthma service in Calderdale and Huddersfield, part of the wider Yorkshire Asthma MDT.  

I look forward to meeting and working with my GP and hospital colleagues to try to improve the lives of our respiratory patients in the Bay of Plenty.”

Contacting the Mental Health Team About Access to Secondary Mental Health Services

Do you have concerns about a client not being able to access secondary mental health services when you think they meet the criteria?
 
Please feel free to contact the relevant team leader through the hospital switchboard (e.g. community team leader, crisis team leader). They are the first port of call if you would like to discuss your queries.

Temporary Suspension of Community Ear Nurse Services (Children Only)

Updated Guidelines on COVID Testing From the Ministry of Health

Kia ora Koutou

The ministry has issued new guidance around COVID testing to start immediately and remain in place for the next 6 weeks.  This is clearly with a view to the significant changes occurring at the moment with the borders having opened to Australia on Monday, the changing global situation and vaccination rolling out across the country.  The full details are included in the report attached here but to summarise the most important points:

• Testing practice is highly variable with numbers dropping off in recent times especially in Maori.
• Vigilance is crucial to ensure we keep COVID as well controlled as it has been to date through early detection of any cases that should emerge in the community.
• The Ministry recommends testing of all those that present with clinical symptoms consistent with COVID 19, with the following exceptions:
• • The decision whether or not to test an elderly person is subject to clinician judgement, with considerations to include the health status or frailty of the person.
  • Symptomatic children who are 11 years and under do not need to be tested routinely unless they meet HIS (higher index of suspicion) criteria, are very ill or a contact of a case or by parental request.
• Bear in mind that newer variants of COVID 19 may present with flu-like symptoms, muscle aches and pains.
• Rheumatic fever throat swabbing should continue as a priority.
• There is a new group added to the HIS criteria – those working in cold storage areas of facilities that receive imported chilled and frozen goods directly from an international air or maritime port.  We are working with Toi te Ora to work out if we have any such facilities within the Bay but remember that staff in such a facility may travel across the country.
• People can experience symptoms after receiving their COVID vaccine which may be difficult to distinguish from those of COVID itself.  Anyone presenting with one or more of the following within 48 hours of receiving either dose of the vaccine should be tested for COVID:
• • Temporary loss of smell or taste
  • Respiratory symptoms (eg sore throat, cough, Shortness of breath, sneezing, runny nose etc)
  • Generalised muscle aches – which are worsening with time
  • Fever of 38 degrees celsius or higher

These guidelines will be reviewed and updated on 26^th May.

The most important take home message is to test patients with symptoms compatible with COVID following the existing guidance for isolation requirements whereby only those fulfilling HIS require full COVID isolation.

Thank you for your help in following this guidance.

Dr Kate Grimwade
Chief Medical Officer
Infectious Diseases and General Physician
Bay of Plenty District Health Board

Young Patients With Swollen Joints - Where to Refer?

A new pathway has been developed between the paediatric and orthopaedic departments at BOPDHB.
 
If you have a patient under the age of 16 years old with one or more swollen joints that you think needs acute admission, please click this link to see which team is best placed to accept the referral.

Reduction in the Blood Lead Notification Level

This update is to advise you that the threshold level at which lead absorption is a notifiable condition under the Health Act 1956 has been reduced.
 

• The previous blood lead level for notification was 0.48 µmol/l (or greater). 
• The new blood lead level for notification is 0.24 µmol/l (or greater). 
• The new notification level came into effect on 9 April 2021.

 
The notification process is triggered when a person returns a blood test with a lead level of 0.24 µmol/l (or greater). The health practitioner (or medical laboratory) must notify this to the local Medical Officer of Health. This enables public health follow up, the source of the lead exposure to be identified, and further exposures and health risks to be managed.
 
Please find details here on how to notify the local Medical Officer of Health.
 
Public health units follow up notifications and manage non-occupational exposures.  If the Medical Officer of Health reasonably believes that any given case arises from workplace exposure then they must advise WorkSafe New Zealand for further follow-up of any occupational risks.
 
Thank you for your assistance with this notification process.

Dr Neil de Wet
Medical Officer of Health
Toi Te Ora Public Health

BOPDHB Grand Round Presentations

Grand Round at Tauranga Hospital is held regularly on Tuesdays (1230-1330) at the Conference Centre (behind the Medical Library) on the ground floor. 

Grand Round is a weekly forum for local and visiting speakers from a range of disciplines. It provides a valuable opportunity for junior and senior hospital medical staff to present on behalf of their departments/specialties'. 

If you would like to join the emailing list to be notified of sessions in advance so you can attend in person or via zoom please email baynav@bopdhb.govt.nz. 

Below are the video links to recent presentations:

• Treatment and Management of COVID Patients (23 March 2021)

* Please note Grand Round presentations are currently postponed while Covid vaccinations are taking place in the conference centre.

Midland HealthPathways Update

New pathways for GPs on HealthPathways
The following pathways are now live on our HealthPathways site for you to use:

• Non-insulin Diabetes Medications
• Insulin for Type 2 Diabetes

And remember there is up-to-date information on all matters Covid-19 for primary care on Health Pathways, including national as well as local information.

HealthPathways is a collection of management guidelines specifically tailored to primary care.  Our GP Liaison team is in the process of 'localising' these pathways to the Bay of Plenty, i.e, making them relevant to GPs and other primary care providers specifically in the Bay of Plenty.  You'll find valuable pointers on history, examination, treatment and of course when and how to refer patients on to other services.  These pathways will, over time, be replacing the Bay Navigator pathways.

Dr Chris Tofield, Dr Dan Jackson, and Dr Paula Taylor

Click here to email the Bay Navigator team