Dr Adams is Dean of the Dunedin School of Medicine. He is an Otago graduate, subsequently training in psychiatry and working for many years at the Ashburn Clinic in Dunedin where he was appointed Medical Director in 1988. He has had extensive involvement with the NZMA initially as a Council delegate, then Board member and subsequently NZMA Chairman from 2001 to 2003. A long term interest in professionalism and ethics led to him becoming Chair of the NZMA Ethics Committee, and leading the current review of the NZMA Code of Ethics. He is a member of the RANZCP Ethical Practice Committee. He teaches professionalism in the undergraduate course in Dunedin, and as Dean has taken a vital interest in the development of the undergraduate curriculum, especially in the further development of general practice and rural programmes. He is a Trustee on the NZ Institute of Rural Health.
What part will General Practitioners play in the future of Undergraduate Education?
Sunday, 22 June 2008
Start 11:25am
Duration: 25mins
Undergraduate education in New Zealand is changing, with an increasing emphasis on early clinical contact, clinical skills and teaching in the community. Developments in the first three years of education in medicine will be outlined, and the continued development in the later years of general practice and rural programmes in Dunedin. Problems in capacity and coordination for teaching in general practice will be presented, and challenges issued to general practice and primary care generally about the part that the sector wants to play in future developments. Integral to this challenge is the tension between the ethical and professional obligation to teach and pass on knowledge, and the �costs� of doing so in our �unbundled� environment. Where do the responsibilities lie?
GP CME 2008 - Dr Pat Alley
Dr Pat Alley
Pat Alley is Director of Clinical Training for Waitemata District Health Board and Clinical Associate Professor in Surgery at the Auckland School of Medicine and Health Sciences. He is a graduate of Otago Medical School and qualified in surgery in 1973. He has spent most of his working life in full time academic and hospital practice. His major research interest is colorectal cancer. He has been a senior instructor for the Early Management of Severe Trauma programme for the Royal Australasian College of Surgeons and still teaches this discipline in overseas countries. For twenty years he has been the Auckland coordinator of the Doctors Health Advisory Service. He is also the intern supervisor for the surgical specialties at Waitemata DHB, is on the panel of performance assessment for the Medical Council of New Zealand and is frequently consulted on matters concerning the organisation and function of surgical departments.
Basic Surgical Skills Workshops
Thursday, 19 June 2008
Start 08:30am
Duration: 120mins
Start 02:00pm
Duration: 120mins
This will cover aspects of diagnosis, punch biopsy, anatomy of needles, suture choice, excision technique and simple suture repair, dog ear repair, principles of wound healing, and sterile wound care. Instruments provided. Practical incision and repair with pig skin. (Limited to 24 attendees)
Advanced Surgical Skills
Workshops
Thursday, 19 June 2008
Start 11:00am
Duration: 120mins
Start 4:30pm
Duration: 120mins
A practical workshop to demonstrate and practice on pig skin some flap repairs suitable for skin cancer work as rotation and advancement flaps. Other flaps as wolfe grafting, split skin grafts, Lazy S and VY repair, and Z plasty will be presented. Discussion on choice of technique, and complications. Instruments will be provided. This workshop is more suitable for GPs with prior surgical experience. (Limited to 24 attendees)
Sutures provided by:
GP CME 2008 - RN Julie Betts
RN Julie Betts
I am currently a nurse practitioner� with a speciality in wound care, employed by Health Waikato. I registered as a nurse in 1980. My background is in surgical nursing including vascular surgery, and district nursing where my interest in wound care developed. Particular areas of interest include management of leg ulcers and the use of manuka honey in wound care.
As a nurse Practitioner in Wound Care the focus of my role is the management of patients with chronic or complex wounds, in both delivering direct patient care and service development to support best practice and improve patient outcomes.
Previous Chairperson of New Zealand Wound Care Society, life member of the NZWCS and founding member of the International Union of Wound Healing Societies. Currently member of education committee, International Union of Wound Healing Societies and National Leg Ulcer Working Party (NZ). Commentator for Evidence Based Journal of Nursing and Nursing Praxis.
Ulcer Management
Saturday, 21 June 2008
Start 8:55am
Duration: 25mins
The management of leg ulcers is a global health problem that challenges health care professionals in most developed countries. Over the last ten years national and international guidelines have been developed to provide health care professionals with a pathway for diagnosing and treating leg ulcers. Despite this challenges still exist in providing cost effective care for this group of patients.
This paper will examine the evidence base that directs current practice in leg ulcer management including the use of diagnostic tools, dressings and compression therapy.
The term cost-effective care, is often used in conjunction with wound care as a means to support a particular methodology in managing a wound, but what does it really mean? Commonly when health care professionals use the term cost in wound care they are referring to the cost of dressings and fail to acknowledge the other determinants of cost associated with wound care. The determinants of �cost-effective� wound care can vary depending on whether you are looking through the �lens� of a patient, health care professional or health care organisation.
Balancing wound care requirements of the patient against organisation stressors of cost and providing �best practice� can be challenging for health care professionals. This paper will examine the determinants of cost-effective wound care based on current evidence, and attempt to provide clarity regarding dressing choice and �cost� in wound care.
GP CME 2008 - RN Angela Browne
Angela Browne - DMU, Vascular Sonographer
A sonographer based in Whangarei since 1991, she holds the Diploma in Medical Ultrasound (DMU) in both General and Vascular specialties, and is currently an accredited practical examiner for both in Australia and NZ. She is the only vascular qualified sonographer north of Auckland, and has initiated and manages the first private vascular ultrasound service in this area, Vascular Ultrasound North.
She has been involved in vein treatment at the Skin and Vein Clinic in Whangarei since 1999, using Ultrasound Guided Sclerotherapy (UGS), and Endovenous Laser Ablation (EVLA) using a Cooltouch CTEV2 1320nm Nd:YAG laser, performing ongoing prospective research in the fields of both UGS and EVLA.
DVT and Post Thrombotic Syndrome
Saturday, 21 June 2008
Start 9:30am
Duration: 20mins
Proximal DVT involving popliteal / femoral veins is a potentially fatal condition from pulmonary embolism (PE). Community DVT incidence is 1-2 per 1000 per year - increased with cancer, obesity, prior DVT / PE, oestrogens, pregnancy, recent surgery / trauma and inherited factors. DVT can now be completely managed in a general practice setting.
Patients present with unilateral leg swelling, which is rarely painful. With a Wells score >2, and D-dimer >200, duplex ultrasound is the gold standard for definitive diagnosis. With evidence of proximal DVT, ideal treatment
is:
Immediate anticoagulation (Clexane stat then at least three months of Warfarin)
Class 2 compression hose for 1-2 years.
Despite adequate medical treatment for DVT, sequelae from impaired venous return may still occur. Effective ongoing compression is frequently inadequate. Post-thrombotic syndrome (PTS) can develop in up to 80% of patients after a proximal DVT, most within 2 years. Symptoms include pain, persistent swelling, hyperpigmentation, and chronic leg ulcers. Lifelong discomfort may result.
Wearing appropriate graduated compression stockings (30-40mmHg at the ankle) for a period of two years after DVT reduces the risk of PTS by 50%. White TED stockings have no therapeutic benefit when ambulant � designed for supine patients during surgery.
Family doctors and their practice nurses can improve outcomes of this common thrombotic condition
by:
Early diagnosis / treatment of DVT
Appropriate use of compression for up to 2 years
Avoiding long-term disability such as PTS
Understanding that TED stockings have no place in the community.
GP CME 2008 - Dr Pat Alley
Dr Brendan Buckley
Dr Buckley has been a specialist in Interventional Radiology at Auckland City Hospital since 2004. He qualified from University College Cork, Ireland in 1995 and then trained in surgery in London obtaining Membership of the Royal College of Surgeons of England in 1998. He trained in Radiology in Oxford becoming a Fellow of the Royal College of Radiologists in 2003. He undertook the Fellowship in Interventional Radiology in Oxford in 2003 before becoming the Interventional Radiology and Angiography Fellow at the University of British Columbia, Vancouver in 2004/05.
Dr Buckley has extensive experience in all aspects of interventional radiology in European and North American settings. He has a special interest in minimally invasive treatment options for common conditions including uterine fibroid embolisation, vertebral compression fractures (vertebroplasty) and pelvic and scrotal venous incompetence (pelvic congestion syndrome and varicocoele embolisation). Dr Buckley has a special interest in Interventional Oncology, developing a radiofrequency ablation program for renal tumours at Auckland City Hospital.
New Help for Back Pain
Friday, 20 June 2008
Start 4:00pm
Duration: 25mins
Osteoporotic vertebral compression fractures (VCF�s) cause increased morbidity and mortality in an already at risk population. Chronic back pain from VCF�s is difficult to manage with opioid analgesia often causing difficult to treat side effects. Treatment of vertebral compression fractures with percutaneous vertebroplasty can provide significant improvement in symptoms in up to 90% of patients, reducing or stopping the need for opioid analgesia. This is a low risk, day case procedure performed under light sedation with patients obtaining immediate improvement in pain control and mobility.
A review of the use of percutaneous treatment for sciatica, facet joint and spinal stenosis related back pain will also be discussed.
Workshop - Gentle Interventional
Radiology
Saturday, 21 June 2008
Start 11:00am
Duration: 55mins
Start 12:00pm
Duration: 55mins
Workshops will run through interventional radiology procedures available for treating common problems seen in general practice including back and pelvic pain. They will allow the opportunity to review case scenarios discussing patient work-up and selection for intervention. There will be the opportunity to demonstrate the techniques and equipment used in interventional radiology procedures. Workshops will also cover treatment outcomes and post procedure follow-up including problems that can present to General Practitioners following treatment.
Pelvic Problems Solved Minimally
Sunday, 22 June 2008
Start 11:00am
Duration: 25mins
Pelvic pathology can be a difficult diagnostic dilemma. Interventional radiology can offer minimally invasive treatment options for patients with specific pelvic pathology.
Uterine fibroid embolisation is an internationally well established uterine preserving treatment for fibroid related disease, including menorrhagia and pressure related symptoms. Being able to inform patients about their treatment options is a key role for the general practitioner. An overview of patient selection, the fibroid embolisation procedure, patient follow-up and outcomes will be reviewed.
Pelvic venous congestion syndrome can pose a difficult diagnostic problem for women. For well selected patients the diagnosis and treatment can have a significant impact for the patient and their ongoing primary care. Diagnosis and treatment options are discussed with expected clinical outcomes.
In men, varicocoele is a common problem. the diagnosis and treatment using minimally invasive interventional radiology will be briefly reviewed.
GP CME 2008 - Dr Peter Chapman-Smith
Dr Peter Chapman-Smith
Dr Peter Chapman-Smith is a full time specialist Phlebologist and Appearance Medicine Physician, who has performed over 5000 Ultrasound Guided Sclerotherapy cases (UGS), and 500 cases of Endovenous Laser Ablation (EVLA) using a Cooltouch CTEV2 ND:Yag laser. Foundation Fellow and Secretary-Treasurer of the NZ College of Appearance Medicine, NZCAM, Fellow of the ACP, FACCS(Medical faculty), FRNZCGP. Extensive microsclerotherapy experience and uses several skin lasers as ND:Yag, KTP and IPL.
Endovenous Laser Ablation of Varicose
Veins
Saturday, 21 June 2008
Start 9:50am
Duration: 20mins
Modern technology has allowed improved efficacy and safety in the management of this common condition, affecting over 40% of the population. Neglected, the long term legacy may be reduced skin nutrition and oxygenation resulting in chronic eczema, ulceration and the public health and personal discomfort costs are high. The high pressure deep venous system communicates with the superficial system with vein dilatation and reverse downward flow. Legs become heavy, may swell, with cramps or burning discomfort, restless legs syndrome, itchiness, worse in hot weather and after standing for long periods. Poor cosmesis may result although some may have no visible varicosities at all. Symptoms do not relate to vein size. A duplex ultrasound scan defines the anatomy prior to treatment. Combining EVLA with ultrasound guided foam sclerotherapy allows closure of refluxing vessels, with relief of symptoms and skin changes can be healed. Patients are immediately ambulant and can resume work or exercise stat. The VTE risk is low compared to older methods as surgery for varices, and those with medical comorbidity as obesity, diabetes, heart lung or renal disease, on Warfarin, of even with previous DVT or PE can be treated. The longer wavelength lasers as the Cooltouch 1320nm NdYag laser target endothelial water, effective with much lower and safer laser fluences. Follow up studies demonstrate their efficacy and safety, with vein closure rates of 97% at 5 years compared to 40% for surgery. Tumescent Klein local anaesthesia allows painfree treatment, displaces nearby tissues as nerves, provides a heat sink for laser energy, and compresses the vein pre treatment to empty the veins of blood. Dressing venous ulcers without treating the cause is expensive and pointless. A 3 year prospective study will be reported.
Healing Venous Ulcers (Practice
Nurses Programme)
Saturday, 21 June 2008
Start 12:30pm
Duration: 30mins
Varicose veins affect about half the population and cause many symptoms, with long term potential problems of discomfort, poor cosmesis, bleeding, varicose eczema and ulceration. Venous ulcers consume a sizeable proportion of scarce health resources, and considerable nursing time and effort. Diagnosis is relatively easy, although varicose veins themselves may not be obvious.
A team approach with family doctors awareness of the problem, then a coordinated approach to treating the underlying problem is mandatory, with good use of nursing skills and an appropriate choice of dressings. Debridement and treatment of secondary infection is often required.
Cost is an issue with DHB budgets restrained and varicose ulcers are not prioritised as life threatening. Most treatment is performed in the private sector, with non surgical options available to those with medical comorbidity, as diabetes, obesity, on warfarin, on dialysis etc.
Better identification of varicose veins and early treatment will prevent this expensive drain on the health system.
Effective compression is rarely used, although prescribed class 2 hosiery is readily available. Chronic venous hypertension, chronic venous insufficiency, and post thrombotic syndrome post DVT contribute. TED stockings (class �) are completely useless in the ambulant patient, designed for supine patients undergoing surgery.
An overview of treatment will be provided.
GP CME 2008 - Dr Mike Cleary
Dr Mike Cleary
Mike Cleary is vocationally registered in Musculoskeletal Medicine.
He graduated from Otago in 1978.
He has since worked in several areas of medicine, including Anaesthetics, General Practice, Military, Musculoskeletal and Occupational Medicine.
After working in the UK he returned to NZ in 1985, to work in General Practice in Feilding.
In 1996, prompted by the changes to Section 51, he quit General Practice Obstetrics and completed the Diplomas of Musculoskeletal Medicine and Occupational Medicine.
In 2002 he left General Practice to work in Musculoskeletal and Occupational Medicine.
In 2003 with a GP colleague he started the Palmerston North Hospital Musculoskeletal Medicine Clinic which has significantly reduced the Orthopaedic Waiting List.
Since 2004, when he completed the requirements to become a Fellow of the Australasian Faculty of Musculoskeletal Medicine, he has accepted referrals from colleagues.
In 2008 he moved to Whangarei to work in a referral based Musculoskeletal Medicine practice where he is learning the skills of interventional spinal injections and diagnostic spinal blocks.
To maintain his interest in Occupational Medicine he works part time for an occupational health company.
�Just do it� - Musculoskeletal Medicine
Workshop (Pre-conference)
Thursday, 19 June 2008
Start 8:30am
Duration: 120mins
Start 2:00pm
Duration: 120mins
There are several straightforward injection techniques which can be used to treat musculoskeletal conditions that are commonly found in General Practice.
These injection techniques include steroid and local anaesthetics and dry needling
The foot is a common cause of pain and other lower limb problems and the diagnosis and management of these will be discussed.
Finally Brian Mulligan�s method of mobilization with movement for lateral elbow pain will be
Injection Techniques for
Trigger finger
De Quervain�s
Carpal Tunnel Syndrome
Low Back Pain (Blomberg�s technique)
Use of shallow needling (a la Peter Baldry) for post arthroscopic meniscectomy pain, post cervical radicular muscle pain and abdominal wall pain
Podiatry 101
Mulligan�s mobilization with movement for lateral elbow pain (www.bmulligan.com)
The Myth of Tendinitis/Tendonitis
Friday, 20 June 2008
Start 9:50am
Duration: 30mins
32 years have elapsed since the histology of tendinosis was first described by Puddu G et al (F. A classification of Achilles tendon disease. Am J Sports Med 1976;4:145�50.)
The histology of patients operated on for tendon pain reveal collagen separation, thin, frayed, and fragile tendon fibrils, separated from each other lengthwise and disrupted in cross section. There is an apparent increase in tenocytes with myofibroblastic differentiation (tendon repair cells), and an increase in matrix.
Other histological findings include calcification, necrosis and neovascularization.
It is important to note that classic inflammatory cells are usually absent.
Despite this fact, chronic overuse tendon conditions that present to General Practitioners are still labeled as epicondylitis, plantar fasciitis and Achilles tendinitis etc.
As General Practitioners are all too aware, the recalcitrant nature of these conditions frustrates the patient, the coach, the employer and the insurer.
While studies have shown that 26 weeks, i.e. 6 months is not an unusual time for symptoms even with standard of care treatment, this timeline is not common knowledge to those affected by tendinopathies.
The continued use of the misnomer �tendinitis� is unhelpful when it comes to managing these chronic conditions as it implies that inflammation is the basis of the pathology.
Who can blame the patient for thinking that anti-inflammatories or steroids are the answer for something labeled as an �-itis�.
Clinical Psychologist, Honorary Lecturer at University of Waikato
Principal Investigator for two projects investigating issues for couples affected by sexual dysfunction, and several others assessing clinical measurement and treatment of sexual desire. Collaborative links have been established with Deakin and Monash Universities in Melbourne investigating the impact of depression on desire and sexual function in couples.
Founding member of Sexual Research Charitable Trust.
Member of Society for the Scientific Study of Sexuality
Associate of International Academy of Sex Researchers.
Helen studied factors influencing sexual desire for her doctorate and immediate post-doctoral years. She has a clinical practice working with patients with sexual dysfunction at The Psychology Centre, Hamilton.
Dr John Conaglen
Associate Professor of Medicine, Waikato Campus, Faculty of Medical and Health Sciences, University of Auckland
Director of Endocrinology at Waikato Hospital
Founding Director of the Sexual Research Charitable Trust
30+ years clinical experience working in the field of sexual dysfunction.
Current research includes a large study assessing the impact of sexual dysfunction on the couple, collaborative studies investigating sexual dysfunction with Deakin and Monash Universities in Melbourne, as well as basic research into genetic and molecular mechanisms of pituitary tumours as well as the impact of growth factors in heart failure.
�WHAT WOMEN WANT�;
Partners� Preference Study:
An examination of preference for tadalafil or sildenafil from the heterosexual partners� perspective
Supported by:
Saturday, 21 June 2008
Start 7:00am
Duration: 30mins
Oral medications for erectile dysfunction (ED) have been available to men for a decade. Previous research has focused on the man�s experience using these drugs. This ground-breaking study investigated the treatment experience of 100 heterosexual couples with ED via interviews and questionnaires. We hypothesised that the female partners would reflect previously described male preference for tadalafil over sildenafil. Understanding the reasons for this from the women�s perspective was the specific aim of this study. We also examined the effect of each treatment on the couples� dynamics with respect to sexual desire and functioning, relationship well-being, quality of life, and general psychopathology. Preliminary analysis has shown significant improvements in couples� sexual functioning and satisfaction, and significant increases in levels of confidence within their sexual relationship. Women also showed overall decreases in psychopathology. Quantitative changes will be discussed in conjunction with the reasons for, and overall preference expressed by the women.
GP CME 2008 - Dr Mark Davis
Dr Mark Davis
Dr Mark Davis is a psychiatrist based in Lower Hutt, Wellington.
He was brought up in Wakefield, Nelson, his father a busy rural general practitioner.
Mark graduated from Otago Medical School in 1976 and completed his post graduate training (in UK and N Z) in 1986.
He worked as a Consultant Psychiatrist to Hutt Hospital, Victoria University Health Service, and has been in full-time private practice since 1995.
Mark is very interested in the area of professional health and well-being, and has written two chapters in the D H A S Book � In Sickness and in Health�, 1998, 2nd Edition.
Mark has had extensive training in psychotherapy, and his own personal journey has led him to explore more effective and practical ways for people to manage themselves and their lives.
He was recently on the N Z Medical Council Education Committee, and was part of a Health Advisory group to the New Zealand Veterinary Association.
For the past five years, Mark has facilitated a Balint group (focussing on Doctor-patient interactions) for Wellington-area General Practitioners. Further groups are planned.
He also has facilitated a number of �Rest, Rejuvenation and Reflection� workshops and retreats for doctors, and their partners.
Mark is married with 4 children.
Communication Skills
Workshop - Listening Well, Speaking Clearly (Pre-conference)
Thursday, 19 June 2008
Start 8:30am
Duration: 120mins
Start 2:00pm
Duration: 120mins
General communication skills training - to improve our relating to patients and others, and so reduce the stress of difficult clients, and complaints.
An introduction to the practice of meditation and stress management--learn the skills to stay calm, focussed, and relaxed, at work and at home.
GP CME 2008 - A/Prof Rob Doughty
A/Prof Rob
Doughty
Dr Rob Doughty is Associate Professor in Cardiology at the University of Auckland and Green Lane Cardiovascular Service, Auckland City Hospital where he works as Director of Heart Failure Services. He is Director of the Cardiovascular Research Group at The University of Auckland, with a wide range of research in cardiovascular medicine. Subspecialty interests include the management of heart failure and echocardiography. He is currently co-chair of the National Heart Foundation Heart Failure Working Group. He also works in private at The Auckland Heart Group.
Breakfast Session
Supported by:
Evidence-based Application of Brain Natriuretic Peptide in Clinical Practice
Sunday, 22 June 2008
Start 7:30am
Duration: 30mins
Biomarkers have an established and expanding role in the management of patients with cardiovascular disease. One such marker, brain natriuretic peptide, is a protein released from the heart when the heart is under stress. Brain natriuretic peptide is a vasodilatory neurohormone, which has several potential roles in the management of patients with heart failure, including screening, diagnosis, assessment of prognosis, and potentially guiding and titrating therapy. Multiple studies have now confirmed its utility for assisting in clinical decision making in patients presenting with symptoms of shortness of breath or peripheral oedema, symptoms of suspected heart failure. The appropriate application of this useful test will be explored in this session with case examples and the limitations of use defined.
GP CME 2008 - Mr David Ferrar
Mr
David Ferrar
David Ferrar is Clinical Director of Vascular Surgery at Waikato Hospital. He has been a consultant vascular surgeon since 2000, having completed the Australasian training programs in General Surgery and Vascular Surgery. His private practice is at Tristram Clinic, Hamilton where he runs a comprehensive varicose vein clinic, performing surgery, endovenous laser and sclerotherapy.
Mr Ferrar has an active interest in vascular ultrasound. He holds the Diploma of Diagnostic Ultrasound and is now an examiner for the Australasian Society for Ultrasound in Medicine. He supervises vascular ultrasound laboratories in Waikato Hospital and Tristram Clinic.
Modern Treatment of
Varicose Veins
Saturday, 21 June 2008
Start 8:30am
Duration: 20mins
Currently there are a number of treatment alternatives in the management of varicose veins. many treatment providers do not offer all of these alternatives, therefore the GP needs to be well informed in order to guide patients appropriately.
Ultrasound is an important diagnostic modality now used for almost all varicose vein patients. Often the ultrasound will guide treatment modality choice.
Surgery, Endovenous Laser and Sclerotherapy are the main options. Rationale for treatment decision will be presented, along with results for over 300 endovenous laser procedures.
Arterial Disease
Saturday, 21 June 2008
Start 9:10am
Duration: 20mins
A logical system for investigation and management of symptomatic lower limb arterial disease will be discussed
Arterial Disease
(Practice Nurses Programme)
Saturday, 21 June 2008
Start 12:00pm
Duration: 30mins
WORKSHOP - How to Heal
Leg Ulcers
Saturday, 21 June 2008
Start 2:00pm
Duration: 55mins
Start 3:00pm
Duration: 55mins
GP CME 2008 - Dr Peter Gendall
Dr
Peter Gendall
Peter has a wide experience in most imaging modalities and a sub specialist interest in spine and musculoskeletal imaging, sports imaging and musculoskeletal intervention.
Peter completed a Fellowship in Musculoskeletal Radiology at the University of Iowa in 1992.
Peter is the Director and Managing Radiologist of Waikato Radiology (formerly Hamilton Medex) and a member of the TRG Group Board of Directors.
Imaging for
Musculoskeletal/Sports Medicine Workshop (Pre-conference)
Thursday, 19 June 2008
Start 11:00am
Duration: 120mins
Start 4:30pm
Duration: 120mins
The Shoulder � Working Together For Improved Patient Care:
Review of mechanism, pathology, imaging findings & imaging guided treatment of shoulder impingement and related problems.
Foot And Ankle � Imaging News:
Use of ultrasound in foot and ankle trauma.
New treatments for chronic achilles tendinopathy.
GP CME 2008 - Dr Pat Alley
Mr Malcolm Giles
Dr Giles is a specialist Otolaryngologist at Waikato Hospital, Hamilton. He qualified from Auckland University School of Medicine in 1979, and became a fellow of the Royal Australasian College of Surgeons in 1986. He became a fellow at the Royal Infirmary in Glasglow in 1988-89, studying the relationship between hearing loss and disability as well as the management of severe hearing loss.
On completing this Fellowship in late 1989 Dr Giles became a full-time consultant Otolaryngologist at Waikato Hospital, where he has worked since. His main areas of practice are Otology, Congenital Deafness, and Otoneurology. He is also heavily involved in teaching, presenting the Otology teaching to the fourth year medical students at Auckland University every year. He also has a yearly teaching session with the Waikato GP training scheme. He is also heavily involved in the New Zealand Society of Otolaryngology, being the Chair of the Education Committee.
Otitis Media
(Practice Nurses Programme)
Saturday, 21 June 2008
Start 11:00am
Duration: 30mins
This presentation will focus on the problems associated with otitis media as encountered in family practice. Issues covered will inclue recurrent acute otitis media- why it matters, how to diagnose it, and when to refer; otitis media with effusion (glue ear)- the same issues; grommets- the vital role of the practice nurse in the long term management.
WORKSHOP - How to...Hearing
Loss Assessment (repeated x 2)
Saturday, 21 June 2008
Start 2:00pm
Duration: 55mins
Start 3:00pm
Duration: 55mins
This workshop will start by discussing types of hearing loss, how hearing is measured, and the effects of diseases on hearing. The second part of the presentation will focus on how GPs should assess and manage patients who present with hearing impairment. The final part will focus on how to manage patients once they have had a hearing assessment, and when and to whom such patients need referring.
WORKSHOP - ENT Case Studies
Saturday, 21 June 2008
Start 4:30pm
Duration: 55mins
I will presenting several patients presenting with dizziness and vertigo. This discussion will focus on the 3 basic presentations of dizziness, and provide a guide to the management of such cases. Benign paroxysmal vertigo will be one of the cases presented, and a movie illustrating the Epley manoeuvre with be shown. This presentation has been given several times to groups of GP trainees, and feedback indicates it was found to be very helpful.
Otitis Media
Sunday, 22 June 2008
Start 9:20am
Duration: 25mins
This presentation will focus on some of the controversial aspects of otitis media of particular interest to GPs. These include: the role of antibiotics in acute otitis media, when to refer recurrent acute otitis media, medical management of chronic otitis media with effusion, and when to refer children with �glue ear".
GP CME 2008 - Dr Melissa Haines
Dr Melissa Haines
Dr Melissa Haines recently joined Waikato Hospital in Hamilton as a consultant Gastroenterologist. Melissa completed her medical training at the University of Auckland in 1999 and subsequently pursued a career in Internal Medicine. After completing the FRACP physician exams in 2003, Melissa trained in Gastroenterology at Waikato Hospital and The Alfred Hospital in Melbourne. Last year she worked as the Inflammatory Bowel Disease Fellow at Box Hill Hospital in Melbourne. Melissa�s interests include luminal gastroenterology, in particular, inflammatory bowel disease, coeliac disease and functional gut disorders.
WORKSHOP - How
to...Management of GORD ( repeated x 2)
Saturday, 21 June 2008
Start 11:00am
Duration: 55mins
Start 12:00pm
Duration: 55mins
Reflux symptoms, heartburn and dyspepsia are common in general practice. Whilst the majority of patients can be managed successfully in the general practice setting it is important to recognize when patients require endoscopy or specialist referral. In this workshop case presentations will illustrate the various presentations of gastro-oesophageal reflux disease and functional dyspepsia, the diagnosis of these conditions, associated complications and management strategies. There will be a focus on the identification of alarm symptoms, when to refer for endoscopy and management of difficult or refractory cases.
Viral Hepatitis (Practice
Nurses Programme)
Saturday, 21 June 2008
Start 3:00pm
Duration: 25mins
Hepatitis A, B and C are the most common forms of viral hepatitis worldwide. In New Zealand hepatitis B virus is a serious public health concern. This presentation will address the impact of hepatitis B in New Zealand, modes of transmission, the natural history and complications of acute and chronic hepatitis B and current treatment strategies. There will be a focus on the importance of reducing the burden of hepatitis B through infant and adult vaccination programmes.
WORKSHOP - How to...Manage
Liver Disease
Saturday, 21 June 2008
Start 4:30pm
Duration: 55mins
In New Zealand chronic liver disease commonly occurs as a result of alcohol, viral hepatitis and non-alcoholic steatohepatitis (NASH). The diagnosis of chronic liver disease and cirrhosis is based on clinical findings, blood tests, liver imaging and liver biopsy. Patients with chronic liver disease may develop a number of complications over time. This workshop focus on the diagnosis and management of complications specific to cirrhosis including fluid overload, ascites, hyponatraemia, peritonitis, encephalopathy and GI bleeding. Issues pertinent to these patients will be discussed such as alcohol avoidance, vaccination, nutrition, hepatoma screening and role of prophylactic antibiotics.
GP CME 2008 - Drs Sarah Hart & Hans Raetz
Dr Sarah Hart & Dr John
Barrett
Appearance Medicine (Pre-conference)
Thursday, 19 June 2008
Start 11:00am
Duration: 120mins
Thursday, 19 June 2008
Start 2:00pm
Duration: 120mins
An introduction to this new field in general practice.
An overview of botulinum toxin, dermal fillers, radiofrequency ablation, medical laser skin hair and tattoo treatments, sclerotherapy for spider veins and chemical peels.
GP CME 2008 - Dr Warwick Jaffe
Dr Warwick Jaffe
Dr Warwick Jaffe has 20 years experience as a clinical cardiologist, and has a special interest in the diagnosis and management of ischaemic and valvular heart disease. Warwick initially trained at Green Lane Hospital followed by overseas experience in the echocardiography laboratory of the University of Washington in Seattle. He returned to Green Lane Hospital in 1990, Since 1999 he has been full time at the Ascot Hospital. Fir the last 10 years he has practiced interventional cardiology. His special expertise is the diagnosis and management of ischaemic and valvular heart disease. He is currently Health adviser to the Samoan Government and travels frequently to Samoa.
A-Z of Coronary Artery
Disease
Friday, 20 June 2008
Start 8:30am
Duration: 30mins
Coronary Heart Disease remains the leading cause of death in New Zealand. Most deaths occur suddenly, in the community � many with no preceding symptoms. Plaque rupture or erosion is the most common mechanism. Risk factor modification is the cornerstone of management in both primary and secondary management, Latest concepts and targets will be discussed. Management of patients with established coronary disease will also be covered. This will include the place of newer imaging technologies such as CT coronary angiography.
WORKSHOP - CVS Case Studies ( repeated x 2)
Saturday, 21 June 2008
Start 2:00pm
Duration: 55mins
Start 3:00pm
Duration: 55mins
WORKSHOP - How to...ECG Case
Studies
Saturday, 21 June 2008
Start 4:30pm
Duration: 55mins
New Concepts in Lipid
Management
Sunday, 22 June 2008
Start 8:30am
Duration: 25mins
Treatment of Lipid disorders continues to evolve. Dietary modification now focuses on reducing total fat content in diet, incorporation of complex foods that are more slowly absorbed and shifting towards monounsaturated plant sterols and fish oils. Reducing LDL cholesterol with statins is the single most important drug therapy � latest targets and thresholds for treatment will be discussed. Statin side effects remain a challenge requiring cessation and then often, rechallenge. The role of ezetemeide is unclear as there are no outcome studies yet. Drugs to elevate HDL are elusive. Newer forms of ncitonic acid may play a greater role in the near future.
GP CME 2008 - Dr Geraldine King
Dr Geraldine King
Geraldine King is a G.P. currently working in Community Health in West Auckland. "Despite more than 20 years in General Practice, I never really understood what Public Health Nurses do until I came to work with them" says this doctor whose varied career has encompassed Drug and Alcohol medicine, the contract at a male remand prison, as well as much rural and urban General Practice both sides of the Tasman.
How the G.P. might respond to the health inequities for marginalised groups in our society - patients who, for many reasons, seem not to optimally access healthcare - is central to Geraldine's work and interests.
Workshop - Tips on
Handling Family Violence (repeated x 2 Invisible Families and their Children at Risk: Practical tips for
Primary Healthcare
Saturday, 21 June 2008
Start 2:00pm
Duration: 55mins
Start 3:00pm
Duration: 55mins
Family Violence and Health: even if we accept that a relationship exists, just how does this apply to Primary Health Care? How can G.P.s tackle a problem that is so often actively hidden? What interventions would be effective anyway?
"Invisible families and their children at risk" are the core business of people like Public Health Nurses and West Auckland Community Medical Officer Dr Geraldine King, a GP herself. Underlying Family Violence is not the only reason often our neediest patients fail to turn up for their Outpatient Clinic appointments, their children's immunisations, attend to their own dental care, present to maternity units unbooked and in labour (.... the list goes on), but it does occur considerably more often and with far-reaching effects on health than we care to imagine. What part might a busy GP play in addressing this very dark secret? Come and hear some practical tips and strategies relevant for GPs that, with a little practice, soon become quick and easy. And that have been proven make real differences to helping turn lives around.
GP CME 2008 - Dr Chris Milne
Dr Chris Milne
Chris Milne is a sports physician in Hamilton. He operated a mixed general and sports medicine practice from 1987-2002, but is now a full time referral based sports medicine practice. He is a Fellow of the Australasian College of Sports Physicians.Team Care:1. Five Olympic and Commonwealth Games teams since 1990.2. Team doctor for Ford World Rally Championship team 1993-95. 3. Team doctor for
three Chiefs Super rugby team 1997 - 2003. Lecturing duties for Oceania National Olympic Committees in various Pacific Islands from 1991 to present.National Chairman of Sports Medicine New Zealand from 1996 to
2006. Medical Director, Northern Region, NZ Academy of Sport 2000 to
2004. Medical Director Rowing NZ 2002- present. President Australasian College of Sports Physicians 2006-2008.
Medical writing- over 20 articles in peer reviewed journals, plus regular columns in NZ Doctor.
WORKSHOP - Case Studies
Sports Medicine (repeated x 2)
Saturday, 21 June 2008
Start 11:00am
Duration: 55mins
Start 12:00pm
Duration: 55mins
a-The ankle sprain that is slow to resolve - consider possible anterolateral or posterior impingement.
b-The tired athlete - Strategies for information gathering that can save you time
c-Medial knee pain in the weekend warrior
d-Lateral hip pain - introducing gluteus medius tendinopathy
WORKSHOP - How
to...Prescribing for Athletes
Saturday, 21 June 2008
Start 4:30pm
Duration: 55mins
There are two groups of athletes. A small minority are elite athletes who are subject to drug testing, and the doctor needs to be aware of commonly prescibed medicines that can produce a postive drug test. The vast majority are ' weekend warriors' who still take their sport seriously. For these people, the doctor or nurse needs to be aware of medicines with either ergogenic or ergolytic properties, and I will give a perspective on these. I will also discuss the vexed issue of 'supplements' and give guidance as to those 'supplements' that actually have an evidence base for their use.
Wrist Conundrums
Sunday, 22 June 2008
Start 8:55am
Duration: 25mins
As clinicians, we often see people who have wrist injuries. The vast majority are labelled ' wrist sprains' and settle in the same timeframe as ankle sprains. In this talk, I will discuss pathologies that are associated with ongoing sequelae eg scapho-lunate ligament rupture, and give advice as to how the GP can pick up such problems.
GP CME 2008 - Dr Diana North
Dr Diana North
Dr Diana North is
a Public Health Physician and Fellow of the RNZCGP. As a General
Practitioner she practiced for ten years in Auckland. She was the
Medical Director for the Heart Foundation of New Zealand from 2000
to 2003. In this role she was involved in the writing of the
Cardiovascular Risk Assessment and Management Guidelines. In 2005-6
she co-wrote the Edge Cardiovascular Risk Assessment and Care
Planning tool for General Practice with Sam Jacobs a qualified
pharmacist with specialized expertise in primary healthcare
information systems. Over the last year she has formed the DrInfo
Company with Sam Jacobs and Peter Wachtell a Financial Services
Specialist with expertise in the operational automation of
data/information use in marketing, underwriting and servicing in the
financial services industry. Diana has a passion for action and
wants to empower primary care.
Claiming to Maximise your Income
Thursday, 19 June 2008
Start 4:30pm
Duration: 90mins
At the hub of primary care are hard working general practitioners and nurses who aim to provide high quality medical care to patients. Despite increasing clinical demands GPs and nurses are spending more and more time performing tasks that are not directly related to treating patients. Is it possible to run an efficient and sustainable business in 2008? Are we:
� maximising the staff roles in general practice
� running efficient effective practice systems
� flexible and responsive to changing demands
� financially sustainable
Can we work smarter?
This is a session to brainstorm the problems and identify potential solutions.
As a general practitioner and public health physician who has created a solution I will show the DrInfo product that aims to strengthen general practice by providing an easy, efficient practice audit and administration system. DrInfo offers:
� Monthly practice audits complete with trend analysis of financial and clinical performance management
� Practice register management and reports to identify patients who qualify for population health programs but are not enrolled to receive program support or funding
� Practice assistance to identify and target specific patient groups who require follow up
� Administration support for contacting patients by mail, email or text with customised letters at the practices request
GP CME 2008 - Dr Louise Reiche
Dr Louise Reiche
Dr. Louise Reiche MBChB, FRACP, MD is a specialist physician Dermatologist practicing in Palmerston North.
Louise graduated from Otago Medical School in 1985 and completed Dermatology post graduate training (NZ and UK) in 1994. Research work undertaken in England with L�Oreal France, was the basis for her MD, �Self-perceived Sensitive Skin� Otago 2002.
Louise worked at Palmerston North Public Hospital (MidCentral) for 10 years, (first year as a general physician) but predominantly as a dermatologist. She now works privately from Aorangi Hospital in Palmerston North.
In addition to general dermatology clinics, Louise runs specialized eczema allergy testing (patch test), mole screening and melanoma surveillance photographic clinics, and minor surgery.
Louise is an active member of the New Zealand Dermatological Society serving on the executive, and for the Cancer Society Vitamin D group.
Acne Simply
Sunday, 22 June 2008
Start 9:45am
Duration: 25mins
Complicated acne grading systems are helpful for research but can be cumbersome in busy clinical practices. By reviewing the histopathology of acne in a clinical context it is easier to understand and to explain to patients why topical agents (e.g. retinoids) are first-line for superficial comedonal acne whereas deeper lesions showing as papules require systemic therapy (e.g. antibiotics, hormonal treatment). Simple and non-oily skin care washing, sunscreen and make-up regimes clarified and tailored to the patient help prevent cosmetic induced or exacerbated acne. Patients with nodulocystic, scarring, recalcitrant, atypical or therapy-resistant acne, or those with severe morbidity ought to be referred to a dermatologist.
GP CME 2008 - Prof Jim Reid
Assoc Prof Jim Reid
Jim Reid graduated in medicine at the University of Otago Medical School in Dunedin. Currently he heads the Department of General Practice at the Dunedin School of Medicine where he is also Deputy Dean. He has a private family medicine practice at the Caversham Medical Centre, Dunedin. He is a Distinguished Fellow of the Royal New Zealand College of General Practitioners and is also a Fellow of the American College of Chest Physicians. He has a special interest in Respiratory Medicine and has published widely in Asthma and COPD. He is a member of the Medical Advisory Panel of the Asthma and Respiratory Foundation of New Zealand, a Director or the Best Practice Advocacy Centre New Zealand, and a past Chair of the International Primary Care Respiratory Group. He is active in research in respiratory medicine and has had wide international lecturing experience.
COPD Revamped
Friday, 20 June 2008
Start 4:25pm
Duration: 25mins
Chronic Obstructive Pulmonary Disease is often classified as a member of the �heart sink series� � patients expect a cure from their chronic cough and shortness of breath when in fact a cure as such does not exist. But �cures� to not exist for many diseases � diabetes, and hypertension to name two. As with these, effective treatments and prevention strategies exist for the treatment of COPD and these have advanced over the last two or three years. Material to be covered will include
� Primary and secondary prevention
� Treatment opportunities including smoking cessation
� The use of bronchodilators.
� The place of steroids, both inhaled and systemic
� The concept of palliative care in terminal COPD.
COPD/Spirometry (Nurses
Programme)
Saturday, 21 June 2008
Start 11:30am
Duration: 30mins
Like all medical investigations the quality of the outcome is only as good as the quality of the input. There are many pitfalls in obtaining high quality results with spirometry, and this short session will outline these. There will be an introduction of the concept of FEV6, as well as how to avoid common errors which produce erroneous results.
WORKSHOP - How
to...Spirometry (repeated x 2)
Saturday, 21 June 2008
Start 2:00pm
Duration: 55mins
Start 3:00pm
Duration: 55mins
It is impossible to manage hypertension without a sphygmomanometer. It is also impossible to diagnose and manage COPD without spirometry. This session will outline the fundamentals of spirometry and the interpretation of spirographs which can be obtained �on the spot� in primary care. The concept of FEV6 will be addressed, and how this may be the appropriate measurement of the future.
Coughin' not Coffin
Sunday, 22 June 2008
Start 11:50am
Duration: 25mins
Cough is one of the most common presenting symptoms in general practice. What is seen there is really the tip of the iceberg as most is dealt with cough medicines obtained from the local pharmacy. However there are many causes of cough and it cause can be elusive and cause difficulties with treatment.
This session will deal with both common and uncommon causes of cough in children and adults, management strategies, and red flags.
Clinical Quiz
Sunday, 22 June 2008
Start 12:30pm
Duration: 25mins
Not telling!!!!
GP CME 2008 - Dr Helen Roberts
Dr Helen Roberts
Dr Helen Roberts is currently Senior Lecturer in Women's Health at School of Medicine,University of Auckland and Research Manager for FPA in Auckland. In 1991 she completed a Masters in Public Health at Yale University and in 1998 became a Fellow of the Australasian College of Sexual Health Physicians. Her clinical, teaching and research interests are mainly in the areas of contraception and menopause. Most recently she has been the clinical leader of the New Zealand Guidelines Group looking at the appropriate prescribing of HRT. She is at present one of the principal investigators with HPV vaccine trials.
Contraception Update
Friday, 20 June 2008
Start 2:00pm
Duration: 25mins
In the last few years we have had changes to the rules regarding the combined pill and the emergency contraceptive pill. There has also been clarification regarding IUD use for young nulliparous women. These will be reviewed along with discussion of the new methods available in NZ-Cerazette (pop), Jadelle ( contraceptive implant) and Postinor
1 (new ecp).
Cervical Cancer Vaccine
Friday, 20 June 2008
Start 2:50pm
Duration: 25mins
Saturday, 21 June 2008
Start 2:30pm
Duration: 25mins
We have recently heard that the MOH is going ahead with implementation of HPV vaccination using the quadravalent vaccine Gardasil. Family Planning in New Zealand has been involved in 2 recent RCTs with the HPV vaccine. Published study results will be presented along with feedback regarding vaccine implementation overseas and what is planned for NZ.
Workshop 25 - How
to...Handling Hormones
Saturday, 21 June 2008
Start 4:30pm
Duration: 60mins
This will be a one hour interactive workshop, with questions and answers. Please bring all your clinical questions regarding contraceptive or menopause problems.
GP CME 2008 - Dr Barry Snow
Dr Barry Snow
Snow was educated at Auckland Medical School. He spent his first house surgeon year at Rotorua Hospital where he learned to catch trout.
After his FRACP examinations in 1983, he pursued geriatrics training before changing to Neurology training at Auckland Hospital. From 1998 to 1995 he taught at the UBC Medical School, Vancouver. There he was engaged in research into Movement Disorders, particularly Parkinson's disease; he has published over 100 papers in the area. He returned to NZ in 1995 to join the Department of Neurology at Auckland Hospital. He is currently Clinical Director of Neurology. In addition to his general Neurology work, he runs a Movement Disorder Clinic and research programme.
New Ways to Think About
Parkinsons Disease
Friday, 20 June 2008
Start 9:00am
Duration: 25mins
A combination of clinical observation and pathology has caused us to change our view of Parkinson�s disease from a dopamine deficiency disorder to a generalized neurodegeneration that spreads through the brain in a reasonably predictable sequence. The initial phases are characterized by loss of sense of smell and sleep disturbance and are followed by the dopamine-deficient movement disorder. The next phase is autonomic instability which is followed by a dementing disorder. Each phase requires different management, both pharmacological and non pharmacological. Each patient also has a different combination of these phases, and thus requires individually tailored treatment.
Pain in the Head
Friday, 20 June 2008
Start 4:50pm
Duration: 25mins
Most chronic headaches are in the migraine-tension type spectrum. Management is focused on education, lifestyle, acute and preventative pharmacotherapy. The general rule for acute treatment is to maximize dosing as early as possible, but be aware of rebound headache. For preventative treatment, the rule is to work up to high doses and give time for the treatment to take effect. Non-migranous headache has specific management and correct classification is critical.
WORKSHOP - Epilepsy for the
Non-Epileptologist ( repeated x 2)
Saturday, 21 June 2008
Start 11:00am
Duration: 55mins
Start 12:00pm
Duration: 55mins
GP CME 2008 - Mr Murray Weatherston
Mr Murray Weatherston
An economist by training, Murray Weatherston is a financial planner and advisor with 30 years of experience in business economics, finance and investments up his sleeve. He set up the company Financial Focus in 1989; is a founder member, past chairman and current board member of the Society of Independent Financial Advisors; and is a former national chairman of the Investment Advisors and Financial Planners Association. You may have also heard his advice over the airwaves � he�s been a regular commentator on matters financial on Radio New Zealand�s Nine To Noon programme for about ten years.
Investment/Financial; current advice on the financial sector, investment and future planning with Murray Weatherston, Financial Focus Ltd, Auckland, and former chief economist for the
Bank of New Zealand.
GP CME 2008 - Frank Weilert
Dr Frank Weilert
Areas of specialisation
Internal Medicine - Gastroenterologist
Specialist Training
Bachelor of Medicine Bachelor of Surgery University of Witwatersrand - South Africa 1991
Fellow of the Royal Australasian College of Physicians - New Zealand 2001
Dr Lucille Wilkinson is an Internal Medicine Specialist working both in General Medicine and Obstetric Medicine at Auckland City Hospital. Born and bred on the West Coast of the South Island, she graduated from Otago Medical School in 1990. Having completed her College of Physicians fellowship in General and Obstetric Medicine , she now has a fulltime post at Auckland City Hospital, working alongside the Maternofetal medicine team. The field of Obstetric Medicine is evolving rapidly, and involves taking a multidisciplinary approach to antenatal care. Lucille�s particular medical interests are drug therapy in pregnancy, HIV infection in the antenatal period and neurological disorders in pregnancy.
Lucille has three young children, an obese cat, no spare time and a very patient husband!
Medical Disorders in Pregnancy
Friday, 20 June 2008
Start 2:25pm
Duration: 25mins
With the change in demographics of pregnancy in New Zealand, there is an increase in prenatal and antenatal medical complications. This session will focus on the diagnosis and management of the more common medical disorders affecting pregnancy � including hypertension, obesity/diabetes, thyroid disorders and epilepsy. New information will be presented regarding the potential problems of commonly prescribed medications including ACE inhibitors, SSRI antidepressants and antiepileptics.
Workshop - How to Antenatal
Diagnosis (Repeated x 2)
Saturday, 21 June 2008
Start 11:00am
Duration: 55mins
Start 12:00pm
Duration: 55mins
A series of antenatal cases will be presented, all involving a common medical complication that would be seen in a General Practice setting. Diagnosis and management options will be discussed.
Medical Problems in Pregnancy
(Practice Nurses Programme)
Saturday, 21 June 2008
Start 2:00pm
Duration: 30mins
The vast majority of women will be entirely healthy in pregnancy. A small proportion have either pre-existing medical conditions, or develop a medical disorder during pregnancy. Pre-pregnancy and early pregnancy assessment can be useful to optimize the outcome of medically complicated pregnancy. This session aims to identify some of the more common medical disorders that occur in the pregnant population, and also looks at more active screening for both obesity related problems and diabetes.
