In the recent past, there have been challenges to the MCNZ on whether we are meeting our legislated mandate of adequately protecting the public through regulation of the medical profession. In the forefront of these challenges has been the previous HDC�s book �The Good Doctor� (Ron Paterson, Auckland University Press 2012). Areas for improvement identified in the book include the provision of information for the public and patients, recertification, performance assessment and the structure of the Council. How does Council respond to these challenges and what directions is it taking in response?

In this presentation I will discuss the management of anxiety using cases to establish salient points including; what may be behind this presentation, what drugs to use and when to worry, risks associated with long-term benzodiazepines and how to approach this.

An accumulation of information and recommendation based on the clinical experience of a number of psychiatrists and myself, including but not limited to: what to expect with antidepressants, how and when to switch antidepressants, psychotropics and pregnancy in brief, interactions and side effects to be particularly aware of, prescribing lithium and managing a patient on clozapine in primary care.

Some 50% of older people with mild cognitive impairment (MCI) � typically memory loss - will progress to dementia, usually Alzheimer�s disease (AD). Other important causes of dementia in the 50 � 70yrs age group include fronto-temporal dementia (FTD), dementia with Lewy bodies (DLB) and vascular dementia (VD). The majority of those with Parkinson�s disease will ultimately develop dementia (PDD). This lecture will discuss the clinical clues to these different disorders and will present the MoCA as a more sensitive bedside test of cognition than the traditional MMSE.

The prevalence of PD is 1-2% in those > 60yrs and 4% in those > 75 yrs. The diagnosis of Parkinson�s disease (PD) depends on the presence of bradykinesia plus one other cardinal sign (rest tremor and/or bradykinesia). There are fascinating new insights into the cause of PD, whilst treatments for advanced PD have improved. These aspects will be discussed but the brunt of the talk will be on the recognition and differential diagnosis of various involuntary movements, illustrated by video. Treatment of these will be briefly discussed.

�Keys to unlock the mysteries of tricky consultations?� 

What allows you as a doctor to swiftly differentiate between the dangerously sick child in need of emergency transport, and the one who is crying loudly but merely upset?

Your training has taught you to look for some quite specific signs and symptoms. 
However, patients also provide other significant information that we don�t always pick up on. In the patient-doctor relationship this information can make the difference between frustration and conflict or good communication and concordance.

Every patient, regardless of age, provides clues as to what makes them tick. Clues that give us useful information to better understand them and their story - if only we know exactly what to look and listen for. Your awareness of these clues makes the process of diagnosis and management much easier for you, as the healthcare professional, than for the worried and less informed parent.

Drawing from the field of neurolinguistic programming, along with the learning and processing models of Myers-Briggs, Kolb and McCarthy, Dr Nigel Thompson will share simple concepts and tools to quickly transform your daily consulting. 

This seminar presents strategies to maximise your chances of success � strategies that are both easy to learn and to immediately implement . Benefits can range from taking a history more easily, to understanding why we may struggle with certain patients more than others; from figuring out why previous management plans were not followed, to helping patients actively engage in their treatment. 

Presenter Bio
Nigel is a well-respected and engaging presenter as well as an experienced GP. He has a family practice in Queenstown and has taught medical undergraduate and postgraduates in the UK, USA and Australia as well as NZ. He is currently a teacher with the Rural Medical Immersion Programme for final year medical students at Otago University. He is also an active member of the Asia-Pacific educational faculty for a major medical indemnity provider.

The algorithm for common sleep disorders will be discussed and how to use it with GP patients. The aim of algorithm is to not only detect common conditions but to find patients with primary insomnia. This is a condition that can often be helped with time in bed restriction, melatonin or sleeping pills. Cases will be discussd to illustrate points.

References
Arroll B, Fernando A, Falloon K10-Minute Consultation
Sleep disorder (insomnia)BMJ 2008;337:a1245

Arroll B, Fernando A, Falloon K, Goodyear-Smith F C Samaranayake Warman G,. The prevalence of causes of insomnia in primary care. Br J Gen Pract 2012; 62:e99-e103. 

Rapid depression assessment and rapid treatment and initiation of prophyllaxis for gout

Rapid depression assessment
There are two screening questions for depression. They have to do with current mood and enojoyment and pleasure in life. If these two questions are both negative the patient almost certainly does not have depression. If one or the other is positive a longer questionnnaire, such as the PHQ-9, needs to done to sort out the false positive tests from the true positive tests.

Rapid treatment and initiation of prophyllaxis for gout. 
It is difficult to get patient back to the clinic after an acute attack of gout for prophyllactic treatment. A rapid treatment for gout is discussed using oral prednisone (having ruled out infection) along with blister packs containing allopurinal and colchicine. The prednisone is given for 2 weeks and the allopurinol for 3 months in increasing doses and then indefinitely.The dose is titrated against the serum uric acid level. The colchicine needs to be continued for another 3 months (total of 6 months). The use of blister packs to ensure that the simplest regimen of treatment is available will also be discussed. Testimonials from grateful patients will be discussed.

Reference. 
Arroll B. How to treat gout and prevent it in 7 minutes NZ Doctor 27 feb 2013 page 23

Not telling!

Many young people do attend a GP, but sometimes we don�t make the most of these encounters. 

There are high rates of manifest or undiagnosed youth mental illness, stress, distress, and alcohol/other drug abuse in the youth population. As GPs, we can do more to support mental wellness for our young people. Practice Nurses can also play an important role in this.

We will review some of the challenges for GPs and PNs around youth mental health, and teach skills around working more effectively with young people experiencing mental health problems. 

HANDOUT: Youth Health Sessions Takeaways

Many young people do attend a GP, but sometimes we don�t make the most of these encounters. 

There are high rates of manifest or undiagnosed youth mental illness, stress, distress, and alcohol/other drug abuse in the youth population. As GPs, we can do more to support mental wellness for our young people. Practice Nurses can also play an important role in this.

We will review some of the challenges for GPs and PNs around youth mental health, and teach skills around working more effectively with young people experiencing mental health problems. 

HANDOUT: Youth Health Sessions Takeaways

The hallmark of asthma is that there is marked improvement or indeed complete resolution of symptoms on treatment either with inhaled corticosteroids or inhaled corticosteroids and long acting bronchodilators. There remains a significant percentage of patients who, despite treatment according to recognised guidelines, are still symptomatic. The commonest reason for poorly controlled asthma is poor or non-compliance which is very common in severe and difficult asthma. Another large group of patients have other co-morbid conditions which mimic some of the features of asthma, these include COPD, reflux induced cough, hyperventilation syndrome and bronchiectasis. Once these conditions have been excluded there are a range of new targeted drugs, mainly monoclonal antibodies, which are being developed, the first of these being the anti-IgE monoclonal antibody Omalizumab.

There is accumulating evidence that COPD is an independent risk factor for cardiovascular disease over and above the effect of smoking. The mechanism for this increased risk could be shared genetic risk factors, spill over of inflammation, mechanical effects of hyperinflation causing cardiac compromise or the effects of either continuous or intermittent hypoxia on cardiac function. In reality it is likely that all of these mechanisms will contribute. This has led to the suggestion that treatment of COPD with respiratory drugs may reduce cardiovascular risk. The most clear cut example of this is smoking cessation where the major reduction in mortality is due to reduction in cardiovascular risk. Evidence is beginning to emerge from clinical trials that treatment of COPD with inhaled steroids and long acting bronchodilators may reduce cardiovascular risk. These are now the subject of larger prospective studies.

How Quitline can help GPs meet tobacco health targets

Smoking remains a leading cause of preventable illness and mortality. More than 5,000 New Zealanders die each year from tobacco smoke and the effects of second hand smoke exposure. Smokers who quit can expect significant life expectancy gains, and the sooner they quit the greater the gain. 

Quitline is New Zealand�s national smoking cessation service. Every year the organsiation helps more than 50,000 New Zealanders beat their addiction. The success rate is very high by international standards and 24.2% of people who sign up to the service are smokefree at six months. The Quitline service is available 24/7 and so can complement other health care services.

The Government has established the goal of Smokefree Aotearoa 2025 and has policies and health targets in place to help support the achievement of this. At PHO level, 90% of enrolled patients who smoke and are seen in General Practice must be provided with advice and help to quit. The Government�s health targets result in an estimated 800,000 �brief advice� conversations a year at PHO level. Each of these conversations should connect to a cessation service.

Quitline has developed an automated referral process which enables all practices using the Medtech Practice Management System to refer patients to Quitline for cessation support directly from their PMS.

Quitline also accepts manual referrals by fax and email and is currently exploring other electronic referral pathways.

Topics covered at this workshop include:

� An overview of the smoking population 
� How Quitline can help you meet ABC targets
� The Quitline service 
� The Quitline referrals process
� Referrals to Quitline via the Medtech Practice Management system

ACC receives many claims for chronic toxicity. Most are from people who have worked with pesticides, solvents, heavy metals or petrochemicals but almost any substance, pungent or otherwise, can be implicated. Claims are also received from those alleging that they have been poisoned by involuntary chemical exposures independent of work. Injuries claimed for include various types of cancers, neurotoxicity, skin diseases, chronic fatigue syndrome, multiple chemical sensitivities and a wide range of symptoms.

Investigating these claims can be difficult because exposure is often historical, in many cases there is no workplace to assess, exposure data are lacking, multiple confounders exist and there may be little in the way of relevant toxicological information on the substances concerned. In addition, many claims are underpinned by a sense of grievance or entitlement. 
In 1998 ACC set up a Toxicology Panel to assess these cases and provide advice on cover and management. In this workshop two Panel members will take you through the evaluation process using selected case studies to illustrate the variety of claims seen, the range of issues to be dealt with and the manner in which decisions are reached. 

As the starting point for most workplace poisoning claims the GP is well placed to advise the patient on the chances of success. It is hoped that the workshop will serve not only to demystify the process but also to help doctors feel less pressured to lodge a claim just because the patient wishes it.

Management of back pain, hip and lower limb problems. How to assess the Locomotor System. �Focus on Function�

The locomotor system is genetically programmed, it is a highly complex system under subcortical control integrating motor function, balancing muscle activity and ensuring centration of joints, essential for normal joint development and optimal motor function. Injury or disturbed motor function affects normal programmed motor activity, there is a reaction of the system to injury/pathology with compensatory and protective motor patterns developing, frequently influencing recovery and often perpetuating dysfunction and pain. In our current medical approach to musculoskeletal problems, there is a focus on pain and pathology, rather than on function. 

This presentation will discuss the normal human locomotor programme based on developmental kinesiology and demonstrate using these principles how to assess a patient with specific injury or dysfunction, how this leads to specific treatment and rehabilitation. Myofascial pain and why this occurs will be discussed. Assessment and management of back pain and lower limb musculoskeletal problems will be presented with clinical examples. 

Cervical mucus is essential to normal conception in the fallopian tube. The presence and characteristics of cervical mucus at the vulva have been unequivocally established as a �biomarker� of serum oestradiol levels which rise at the time of ovulation. Cells producing mucus in the crypts of the cervix are richly endowered with oestradiol receptors. Charting observations at the vulva assist a couple in understanding their fertility. This self knowledge can be a powerful tool in reducing anxiety and potentially achieving pregnancy in sub fertile couples pre or post IVF. 

HANDOUT: BOM Chart and Graph and Resources for BOM 

Early and prolonged contraceptive use delaying first pregnancy is contributing to rising rates of infertility. What can a practice nurse offer a woman who: does not qualify for IVF, is awaiting IVF, or has not achieved pregnancy through IVF? 

HANDOUT: BOM Chart and Graph and Resources for BOM 

Perimenopausal women have a range of symptoms and specific health needs. Explaining the climacteric in simple language can help allay many common concerns and anxieties. Enabling her to observe the cervical mucus symptom as a marker of ovarian activity gives her self knowledge as to where she sits in the hormonal transition. This knowledge can be used to enable her to avoid pregnancy if necessary. An overview of the climacteric will be given and a short practical guide on how to make the decision to prescribe hormone therapy safely.

HANDOUT: BOM Chart and Graph, Resources for BOM and Menopause Resources

How many times do we hear people ask 'are you a specialist, or just a GP?'. The suggestion that general practice is a dumping ground for a failing health system would suggest it is a dumping ground for failing doctors as well. So the question is timely put, and the evidence needs to be scrutinised ... is it a dumping ground? are we good at it? can specialists do a good dump? is it just to place General Practice in such a position and is 'just' another four letter word?"

From 7pm guests arrive: Otago Settlers Museum, Josephine Foyer. 
Background music on entry until 7:30pm
7:30pm Welcome speeches and guests invited to buffet table by table 
8:20pm Debate until approx 9:00pm 
"Why Doctors Would Beat Lawyers to the Summit of Everest"
Lawyer 1 David More
Lawyer 2 Sally McMillan
Doctor 1 Buzz Boothman-Burrell
Doctor 2 Kathryn Dalziel
9:00pm Dessert buffet open 
9:15pm Band �Girl Friday� until 11:30pm

Dr David Bratt is first and foremost a General Practitioner who spent 30 years in front-line general practice enjoying the delivery of individual face-to-face health services. In 2002 a new opportunity presented itself to improve patients� access to specialist secondary services and close the gap in the primary/secondary interface with his appointment to the new position of GP Liaison and Primary Care Advisor to Capital and Coast DHB. This exposure to a large multilayered organisation required a whole new set of skills and an understanding of the relatively slow pace of change possible compared to a typical small business general practice. A further leap into the unknown occurred in 2007 with his appointment to the new position of Principal Health Advisor to the Ministry of Social Development. This is General Practice at a systems level � working with a population around the wider social determinants of health � employment, income, housing, education, and access to health services. In this position he had to opportunity to work on collecting together the substantial body of evidence on the health benefits of work, and the significant adverse health outcomes of worklessness.

Believe it or not it is not that many years ago that doctors were encouraging their patients to smoke. Smoking was thought to be not only useful for relaxation but also for respiratory conditions. How times have changed in the light of evidence. Just as destructive of a person�s health as smoking is unemployment or worklessness. What is more distressing is this is also often introduced and perpetuated by doctors. This workshop looks at the evidence and practice to support the imperative for GPs to refocus away from illness, disease, disability and incapacity and towards health, ability and capacity. Currently 330,000 (1 in 8) working age New Zealanders depend on a benefit for income, as do 1 in 5 New Zealand children. The adverse effect of this on their health is very well documented. The Government is moving to reform the welfare system to have a more pro-active approach. What is the role of the GP in the reforms? This workshop explores this and ways you can better manage this significant social and health issue in your practice. It is about making doing the right thing, the easy thing to do.

General Practice is well placed to contribute in a number of ways to reducing the relatively high rates of suicide in New Zealand . This session will review how to assess and manage patients at risk of completing suicide. It will also explore the initiatives that practices can support to build the resilience of their patients and their families/whanau and the wider community. 

This will be an interactive session for Practice Nurses to further develop their knowledge and skills when working with people who present with mental health and or addiction problems.

Common mental health problems will be discussed and suggestions for improving engagement and recovery will be offered.

Practice Nurses will have an opportunity to discuss relevant cases if time permits.

1. Vaginismus and Dyspareunia
2. Primary and Secondary Amenorrhoea

Primary and secondary amenorrhoea
This aims to recap some the physiology involved in menstruation and the difficulties with some of the definitions used. The endocrine problems responsible will be discussed at the various levels of the H-P-O axis rather than in the context of primary or secondary symptoms. Hopefully, this will emphasis result in a pragmatic and management based approach to this subject.

Self Psychology in the 15 Minute Consult

Understanding self psychology will enhance the therapeutic dynamic of the doctor patient relationship. 

The work shop will provide us with a better understanding of what is going on between us and patients and how self psychology can be applied in the primary care setting through our conversation. Self psychology relies upon a therapeutic dialogue. We will use a conversational model and the analogy of the �playroom� to better understand what actually transpires in the course of any interaction between ourselves and patients.

Self psychology developed at a time when the traditional psychological modalities were failing. This coincided with an increase in maternal infant research and the development of the new psychotropic drugs.

We all have heart sink patients who frustrate us. Having a better understanding of the reasons why such patients continue to present, when and how they do, makes managing such (untreatable) patients much less stressful. A self psychology perspective can alter our interventions with all patients from distancing (through specialist referral and disengaging prescribing) to a more intimate constructive relationship based on empathic understanding. 

The aims of the workshop through illustrated case studies will be to 
� Understanding the concept of self
� To understand the significance of the self/selfobject matrix (cf: early mother infant environment) 
� To explore the values of intimacy and empathy
� To lighten the burden we all experience with our heart sink patients
� To look at the conversational model for implementing the ideas of self psychology and inter subjectivity

• Pre-course reading 4-6 weeks in advance to help prepare for the test.
• Basic Life Support
• Advanced airway management (bag masking progressing to intubation)
• AED and rhythm recognition
• Adult and child collapse algorithms 
• Anaphylaxis management 
• A compulsory multi choice test and skills evaluation of airway management, defibrillation and some cardiac rhythms
  

Many patients with diabetes fail to achieve targets for glycaemic control because of inappropriate use of insulin. Patients and health care professionals face many potential barriers to insulin initiation and intensification in primary care. These can be categorised as low motivation, lack of familiarity or experience and time constraints. Type 2 diabetes is progressive in nature and many people with the condition will inevitably require insulin therapy to attain and maintain adequate glycaemic control. My presentation is about exploring the nature of these barriers and offers suggestions and practical solutions for addressing and overcoming these hurdles so that insulin can be initiated confidently and appropriately in order to improve diabetes care in Primary care. Goal of the workshops will be about different insulin profiles, selecting and using devices, troubleshooting injection issues and knowing what key information to impart when starting someone on Insulin.

How Quitline can help GPs meet tobacco health targets

Smoking remains a leading cause of preventable illness and mortality. More than 5,000 New Zealanders die each year from tobacco smoke and the effects of second hand smoke exposure. Smokers who quit can expect significant life expectancy gains, and the sooner they quit the greater the gain. 

Quitline is New Zealand�s national smoking cessation service. Every year the organsiation helps more than 50,000 New Zealanders beat their addiction. The success rate is very high by international standards and 24.2% of people who sign up to the service are smokefree at six months. The Quitline service is available 24/7 and so can complement other health care services.

The Government has established the goal of Smokefree Aotearoa 2025 and has policies and health targets in place to help support the achievement of this. At PHO level, 90% of enrolled patients who smoke and are seen in General Practice must be provided with advice and help to quit. The Government�s health targets result in an estimated 800,000 �brief advice� conversations a year at PHO level. Each of these conversations should connect to a cessation service.

Quitline has developed an automated referral process which enables all practices using the Medtech Practice Management System to refer patients to Quitline for cessation support directly from their PMS.

Quitline also accepts manual referrals by fax and email and is currently exploring other electronic referral pathways.

Topics covered at this workshop include:

� An overview of the smoking population 
� How Quitline can help you meet ABC targets
� The Quitline service 
� The Quitline referrals process
� Referrals to Quitline via the Medtech Practice Management system

Worldwide, all health systems are under enormous pressures of supply and demand. As such, many governments have challenged the traditional role of the doctor and called for broader leadership throughout the profession....but what is the core role of the doctor? What do they mean by leadership? And what do we mean by profession?

This is a 'rapid fire' presentation of multiple practice points which will include early referral for patients with inflammatory afthritis, practical management of gout, when to order the ANA test, practical tips on treating patients with PMR and GCA, Methotrexate, injection of carpal tunnel syndrome, the thype'and expense of ultrasound guided injections in Rheumatology, vaccinations for immunosuppressed rheumatic patients and advances in the treatment of Raynaud's phenomenon.

Audience participation is encouraged.

HANDOUT: Injection with Methylpredniosolone

There are currently two biologics which are both TNF inhibitors, Adalimumab (Humira) and Etanercept (Enbrel) which are funded by Pharmac in its Community Schedule (Section B). When Pharmac takes over DHB Pharmaceutical funding from 01.07.2013, Rituximab, a B-cell maturation inhibitor is likely to be available for treating patients with rheumatoid afthritis who have failed TNF inhibitors. With more uniform national funding of IV biologics in DHBs for rheumatology patients, it is important that GPs are aware of these new medications, the rationale for their taigets in the diseases they are treating and potential adverse effects.

Biosimilar biologics are being developed, and biosimilar Infliximab, another TNF inhibitor which is given intravenously is available in certain countries.

A new chapter in anti-rheumatic therapies dawned on 06.11.2012 when the first of the small molecule immunomodulators (Tofacitinib or Xeljanz) which is a Janus kinase (JAK) inhibitor for moderate to severe rheumatoid arthritis was approved for commercial use by the FDA, These new class of agents target the intracellular signalling pathways and are given orally. The price of Tofacitinib is slightly cheaper than that of biologics in USA but they have the potential to be much cheaper because of cheaper manufacturing costs especially as there are a number in development.

M genitalium is a bacteria of the Mollicutes ( mollis �soft,cutis skin ) class and is remarkable in being the smallest of any free living cell with no cell wall but a plastic cell membrane.It has the smallest known genome (580kb) which code for less than 500 genes Consequently this bacteria is parasitic to get the nutrients it needs and fastidious in growth requirements. It is no surprise that this is difficult to culture and it wasn�t until 1980 that it was finally isolated from the urethras of 2 men with urethritis. With the advent of nucleic acid amplification technology ,epidemiological studies were possible to determine its pathogenicity and associations. These will be discussed and a suggested treatment pathway outlined.

This workshop will focus on the specifics of taking a sexual history and the process of contact tracing. There have been new guidelines on STIs recently published and these will be discussed and in particular handling the problem of less than perfect tests in very low prevalence settings.

Early infectious syphilis continues to a be a significant problem in NZ. Because a painless ulcer which resolves may not give rise to concern and because of its protean manifestations in the secondary stage ,syphilis is easily missed. Current epidemiology will be presented and case studies discussed to illustrate diagnosis. An overview of the Christchurch 2012 outbreak will be presented. Because syphilis became so rare it became neglected in medical school curricula so come to this workshop to catch up.

Prostate cancer screening has been a contentious issue for 20 years since PSA testing became available about 1993. Randomised trial results have not confirmed its place as an acceptable method of screening for prostate cancer. The impact of prostate cancer screening on prostate cancer incidence and mortality in New Zealand will be described. 

The incidence of some cancers has been associated with exposure to ultraviolet radiation. The most consistent association is with melanoma. However, low levels of Vitamin D have also been linked to some bone and muscle diseases and possibly colorectal cancer. This has resulted in speculation that sunscreen use and sun avoidance behaviours resulting in low levels of Vitamin D may increase the risk of some diseases. The evidence for and against these associations will be presented for discussion.

Four randomised trials have shown consistent results that once-only FS between 55 and 64 years of age reduces the 11-13 year mortality from bowel cancer by about 43%. Over the long-term it also reduces the risk of developing bowel cancer by a similar amount. One-off FS screening conducted by trained genarl practitioners or nurses, as occurred in the UK trial, would only increase the demand for colonoscopy by about 10%, compared to 50% for 2-yearly iFOBT screening, and therefore may be manageable without considerable delay. The arguments for and against a one-off FS screening programme will be presented and discussed.

What don�t you know you don�t know � maybe we can help?

ACC Treatment Injury (TI) Centre, Lower Hutt, New Zealand

Did you know:

� In 2005 the Accident Compensation Act 2001 was amended
� ACC no longer needs to establish medical error to cover a treatment injury
� ACC receives over 5,000 treatment injury claims per annum

In which case do you know:
� When/how to lodge a TI claim
� What kinds of events involving General Practitioners are resulting in injuries
� How the legislation works
� If ACC can report you to the Medical Council

If you don�t know the answers Chris and Brendan invite you to join them for a discussion about all things Treatment Injury. At the end of the session we hope that you will understand more about TI and the benefits of lodging claims for patients.

From 7pm guests arrive: Otago Settlers Museum, Josephine Foyer. 
Background music on entry until 7:30pm
7:30pm Welcome speeches and guests invited to buffet table by table 
8:20pm Debate until approx 9:00pm 
"Why Doctors Would Beat Lawyers to the Summit of Everest"
Lawyer 1 David More
Lawyer 2 Sally McMillan
Doctor 1 Buzz Boothman-Burrell
Doctor 2 Kathryn Dalziel
Adjudicator: John Adams 
9:00pm Dessert buffet open 
9:15pm Band �Girl Friday� until 11:30pm

KiwiSaver for the employer and employee.

Kiwibank presentation will cover areas such as the importance of relationship banking, financial tools to enable managers to grow their business and key considerations, such as electronic banking. There will be a Q & A session covering any concerns or issues the mangers have over their current banking relationships.

In the usual no nonsense approach taken by Gareth Morgan Investments creating wealth is one thing but how do you make sure you don�t �loose the bloody stuff!�.

The session will also discuss the key issues in building your own private portfolio, the importance of a well diversified portfolio that is liquid and transparent. It will cover the major asset classes, shares, fixed interest and cash and key tips on wealth preservation.

Can social media help you as a GP? Facebook started in 2004, Twitter in 2006 and since then a plethora of other social networking platforms have burst onto the ether. This presentation will cover who in medicine is using social media and what, if anything, it means for general practice and your business.

Agenda
7.30pm � Arrival
7.45pm � Dinner
8.15pm � Speaker Dr Gerry Devlin
9.15pm � Dessert Served
9.45pm � Meeting concludes

Brilinta (ticagrelor) is the first oral antiplatelet to reduce CV death compared to clopidogrel in ACS patients . Waikato Hospital has initiated more than 900 patients onto Brilinta through the Brilinta Access Programme, so join us to hear Dr Devlin share his experience and knowledge.

Primary and secondary amenorrhoea
This aims to recap some the physiology involved in menstruation and the difficulties with some of the definitions used. The endocrine problems responsible will be discussed at the various levels of the H-P-O axis rather than in the context of primary or secondary symptoms. Hopefully, this will emphasis result in a pragmatic and management based approach to this subject.

Abnormal and heavy vaginal bleeding
As these are common presenting symptoms from a gynaecological perspective, much of the subject matter will be well known to all concerned. The difficulty can however lie in differentiating between normal and abnormal, when to refer, what investigations to organise and what treatment to offer in the interim.

Type 2 diabetes is a progressive disease which needs progressive therapy for optimal glycaemic management and prevention of dreaded complications. This workshop aims to enhance knowledge and skills required of primary care practitioners for ongoing management of insulin therapy in the primary care. The participants would be expected to have had some prior experience in insulin treatment of type 2 diabetes patients and have attended the basic insulin initiation workshop. This workshop will try to address some commonly encountered practical management issues that may arise after a successful insulin initiation programme for type 2 diabetic patients. 

Type 2 diabetes is a progressive disease which needs progressive therapy for optimal glycaemic management and prevention of dreaded complications. This workshop aims to enhance knowledge and skills required of primary care practitioners for ongoing management of insulin therapy in the primary care. The participants would be expected to have had some prior experience in insulin treatment of type 2 diabetes patients and have attended the basic insulin initiation workshop. This workshop will try to address some commonly encountered practical management issues that may arise after a successful insulin initiation programme for type 2 diabetic patients.

Buprenorphine as a new opiate substitute therapy � �Back to the Future� 

Many GPs will remember Buprenorphine ( Bup ) as �Temgesic�, a sublingual opiate analgesic used in the 1980s and 90s. Unfortunately it became very popular among injecting drug users and was eventually taken off the market. 

Now Bup is back , as �Suboxone� , a combination of Bup and Naloxone. This sublingual medication was subsidised by PHARMAC in July 2012 for use in opiate detox and also in opiate substitution treatment ( OST ), as an alternative to methadone.

This presentation reviews the pharmacology of Suboxone, compares it with methadone, and discusses the implications of its use in General Practice  

Oxycodone is a potent opiate analgesic that is changing the landscape of opiate prescribing in New Zealand. In the U.S.A. and Australia a marked rise in Oxycodone prescribing resulted in a corresponding increase in Oxycodone-related ED presentations , overdose and death. The emerging picture of Oxycodone prescribing in N.Z. appears to be following a similar pattern, raising the possibility that a rise in Oxycodone-related deaths will surely follow. 

This prescribing pattern is at variance with published advice from Medicine�s Control and BPAC , both of whom recommend using Oxycodone as a second choice after morphine. The preference for Oxycodone among prescribers is puzzling in the light of this advice , particularly when one considers the cost of Oxycodone , which is twice as expensive as morphine . 

Some possible reasons for Oxycodone�s popularity are outlined in this presentation, as well as a brief discourse on the role of opiates in the treatment of chronic non-malignant pain. 

This presentation is a call to health professionals to take heed of the experiences in other countries so that we may avoid the same resulting harm from Oxycodone in N.Z.

1. Vaginosis and Vulvitis (�Something Wrong Down There?�)
2. Practical Management of Ovarian Cysts

How does one approach a possible diagnosis of endometriosis in a general practice setting? What is a sensible pragmatic way of managing the symptoms of possible endometriosis? How does one investigate? By suggesting the diagnosis, does one commit a patient to a roller coaster ride of surgery after surgery? Practical advice on how to investigate and manage endometriosis in a general practice setting will be presented.

Can social media help you as a GP? Facebook started in 2004, Twitter in 2006 and since then a plethora of other social networking platforms have burst onto the ether. This presentation will cover who in medicine is using social media and what, if anything, it means for general practice and your business.

A profound reform of models of healthcare, service configurations and consequent workforces, IT systems and capital expenditure is necessary if the New Zealand healthcare system is to be fit for purpose, affordable and sustainable. The cost of healthcare, given current configurations, is expected to increase by 8% per annum. The major drivers in this context are the ageing of the community and the costs of recruiting and retaining what will also be an ageing healthcare workforce to meet that demand. The need for substantial reform is also underpinned by a change in disease burden over the last several decades. What was predominantly an acute disease burden, and often communicable, is now predominately that of chronic noncommunicable disease. Whereas a doctor-led, sub- specialised and hospital-based health system was a sensible response to the former, it is a very inefficient and generally inappropriate way of addressing current and future demand. Some substantive barriers to reform have been identified and are being managed. The most important of these is a shortfall in clinician leadership and a paucity of useful health system intelligence. In order to slow down the rate of hospital build, and to sequentially shift healthcare out of hospitals and in turn into community-settings, and into the home, the following will be essential: an electronic shared care record; a new way of funding and rewarding providers and consumers; a diversified community-based healthcare workforce that places a priority on general scopes of practice and "working at the top end of licenses"; and, real 'patient' ownership of health through enhanced health literacy.

Workshop will cover use of implantable contraceptives . Following presentation there will be a practical session in technique for insertion of jadelle . This will be supported by Bayer pharmaceuticals .

Type 2 diabetes is a progressive disease which needs progressive therapy for optimal glycaemic management and prevention of dreaded complications. This workshop aims to enhance knowledge and skills required of primary care practitioners for ongoing management of insulin therapy in the primary care. The participants would be expected to have had some prior experience in insulin treatment of type 2 diabetes patients and have attended the basic insulin initiation workshop. This workshop will try to address some commonly encountered practical management issues that may arise after a successful insulin initiation programme for type 2 diabetic patients.

What really works? Turning Knowledge About Equity In Healthcare Into Action

Healthcare equity is a major theme in the New Zealand environment as growing evidence from research and service evaluations shows that, in general, Maori and other ethnic minorities continue to receive a lesser standard of care compared to European New Zealanders. This occurs even when Maori attend as often as others or after adjustment for age and income levels. 

The Health Practitioners Competence Assurance Act (2003) required New Zealand registration authorities to develop standards of clinical competence, cultural competence and ethical conduct. Attention has now turned towards ensuring registered health professionals develop and maintain cultural competence. 

The workshop will begin with a presentation on the evidence about what works to improve health equity. The interactive section of workshop will guide participants to identify potential responses to ethnic inequalities in service delivery and healthcare outcomes. 

Participants will be able to identify progress within their own workplaces and identify barriers to progress.

The last decade has seen much progress in the management of the spondyloarthropathies; the availability of effective treatments has been life transforming for many patients who have previously suffered the inflammatory back pain, peripheral arthritis and/or extra articular manifestations of these conditions. An overview of the classification of these conditions and a discussion of the symptoms and signs that may be helpful diagnostically, will be followed by a discussion on referral guidelines and treatment algorithms.

Use of text-messaging in General Practice � New Recall Contact List feature for Medtech32.

If you have been thinking about using mobile text-message communications with your patients then this is the workshop for you. Come in and find out how 

� The doctors and nurses can make their life to communicate test results
� Improve your recall process, save nurse time on less administration and more clinical work
� Utilise the new recall function to make recalling very easy and effective
� Learn about how you can streamline Smoking A and B under Txt2remind and do both of these functions seamlessly
� Improve patient response 
� Patient privacy and safety

Use of text-messaging in General Practice � New Recall Contact List feature for Medtech32.

If you have been thinking about using mobile text-message communications with your patients then this is the workshop for you. Come in and find out how: 

� Doctors and nurses can make their life easier to communicate test results
� Improve your recall process, save nurse time on less administration and more clinical work
� Utilise the new recall function to make recalling very easy and effective
� Learn about how you can streamline Smoking A and B under Txt2remind and do both of these functions seamlessly
� Improve patient response 
� Patient privacy and safety

From 1992 until 1998 he held Senior Staff Radiologist positions and Clinical Senior Lecturer status until 2003. In 2003 Ross moved to Perrett Medical Imaging which was subsequently incorporated into Medical Imaging Australia Group (MIA). It was at this time that Ross became a founding Partner of Adelaide Cardiac Imaging (ACI), a joint radiology-cardiology venture. Dr Keenan worked with Professor Stephen Worthley (Cardiologist) in setting up the cardiac MRI arm of this venture.

Ross returned to New Zealand in 2004 and joined Christchurch Radiology Group (CRG) as a partner and was instrumental in the formation of Heart Vision a joint venture specialising in provision of cardiac CT, being Managing Director since 2007. 2009 saw Ross further expand CRG cardiac imaging with establishment of an echocardiography service.

Ross currently holds a 7/10 position as a Neuroradiologist in Christchurch Hospital and provides cardiac CT/MRI expertise in both public and private settings.

In 2010 Dr Keenan was credentialed with CTCA Specialist status by the Conjoint Committee for the Recognition of Training in CT Coronary Angiography (CCRTCTCA). This conjoint committee comprises RANZCR, CSANZ and ANZAPNM.

Dr Keenan has fulfilled the training criteria for NZ CT-PET specialist recognition, and is currently in the process of a formal application. 
Ross has been extensively involved in RANZCR affairs in both Australia and NZL, sitting on the RANZCR executive for 6 years including a year as Treasurer. Teaching has been a large part of Ross�s career being seconded as a Neuroradiology examiner for the College of Radiologists since 2000 and actively involved in the Christchurch Radiology Training programme.

Despite the increase in the global burden of stroke, advances are being made. 
In 2008, after years of being the third leading cause of death in the USA, stroke dropped to fourth.
In part, this may reflect the results of a commitment made by societies such as the American Heart Association/American Stroke Association (AHA/ASA) over the last decade ago to reduce stroke, coronary heart disease, and cardiovascular risk by 25% by the year 2010.

In this workshop, it is planned to review stroke mimics, the imaging of acute strokes in the setting of an acute stroke unit as well as the more difficult area of subacute-chronic stokes.
With the introduction of the modern acute stroke management and the tertiary acute stroke unit in management the critical role of acute neuroimaging has been exemplified in the triaging of acute stroke. 
Neuroimaging however has a broader utility in the investigation of the non-acute stroke, an area which may be clinically more problematic. A wide ranging review cerebrovascular disease neuroimaging is planned to provide a platform for the understanding of cerebrovascular disease pathophysiology manifesting as clinical stroke.

Any surgical procedure, no matter how minor, exposes the patient and the doctor to dangers. Basic safety measures in handling sharps and use of instruments, coupled with appropriate clinical knowledge and care, are the minimum requirement for anyone practising even the most minor surgical procedure. 

This session will begin with a safety framework, introduce basic surgical instruments and discuss their selection and use for minor surgery of the skin. In a hands-on interactive session, you will learn how to select and use appropriate needles and sutures, and perform incisions and excisions mindful of skin tension (Langers) lines. You will practise knot tying and simple suturing techniques, and consider post operative wound cares.

Covers transposition flap, advancement flap, and as time allows, full- thickness skin graft, dog ear repair, Z plasty. Previous attendance at the Basic Surgical Skills Course, or prior practical experience a pre-requisite for attendance.

Mental Health and addiction services have undergone significant changes in the last 20 years. Over the next decade services will continue to change in response to high levels of un-met need as an ongoing Government priority. This presentation will provide a brief overview of the initiatives underway across multiple sectors, including health, to improve mental health and well being for everyone. It will discuss how general practice is responding to the challenge of providing more support to people with mental health and addiction problems and the opportunities for future service development.

The goals of the presentation is to describe the radiologic diagnosis of DVT, and summarise the current literature for radiological treatment.

The goals of the workshop is to describe an approach to interpretation of the abdominal x-ray.

Many young people do attend a GP, but sometimes we don�t make the most of these encounters. 

There are high rates of manifest or undiagnosed youth mental illness, stress, distress, and alcohol/other drug abuse in the youth population. As GPs, we can do more to support mental wellness for our young people. Practice Nurses can also play an important role in this.

We will review some of the challenges for GPs and PNs around youth mental health, and teach skills around working more effectively with young people experiencing mental health problems. 

HANDOUT: Youth Health Sessions Takeaways

Many young people do attend a GP, but sometimes we don�t make the most of these encounters. 

There are high rates of manifest or undiagnosed youth mental illness, stress, distress, and alcohol/other drug abuse in the youth population. As GPs, we can do more to support mental wellness for our young people. Practice Nurses can also play an important role in this.

We will review some of the challenges for GPs and PNs around youth mental health, and teach skills around working more effectively with young people experiencing mental health problems. 

HANDOUT: Youth Health Sessions Takeaways

Many young people do attend a GP, but sometimes we don�t make the most of these encounters. 

There are high rates of manifest or undiagnosed youth mental illness, stress, distress, and alcohol/other drug abuse in the youth population. As GPs, we can do more to support mental wellness for our young people. Practice Nurses can also play an important role in this.

We will review some of the challenges for GPs and PNs around youth mental health, and teach skills around working more effectively with young people experiencing mental health problems.

There is good evidence that appropriately applied testing for high risk (oncogenic) types of human papillomavirus (hrHPV) can play a useful and cost effective role in the management of women with abnormal cervical smears.
Most HPV infections clear naturally. However in some women, HPV infection can develop into a persistent infection, causing changes to the cervix which if untreated will develop into cervical cancer.
In 2009, the National Cervical Screening Programme introduced hrHPV testing in three clinical situations: 
- Women 30 years and older with low grade changes, to help assess risk of progression
- Women of all ages treated for a high grade lesion, to help assess whether the lesion has been resolved
- Where colposcopy has shown unclear results, to help interpret these results 

This workshop will cover HPV risk, pathogenesis, transmission, and indications for hrHPV testing as part of the Guidelines for Cervical Screening in New Zealand. Case scenarios will be used to illustrate when to request a hrHPV test and how to interpret hrHPV test results.

The National Cervical Screening Programme (NCSP) in New Zealand was established in 1990. Cervical smears are offered to women between the ages of 20 and 69 years at 3 yearly intervals. The Health Act 1956 (amended in 2004) underpins the NCSP�s operations to ensure the co-ordination of a high-quality screening programme. Overall coverage for the total population is approximately 75% (hysterectomy adjusted). Among European women, 3 yearly coverage has increased steadily from about 75% in the early 1990s to about 85% today. Coverage for Māori women however has increased more rapidly only in the last 5 years from about 50% to approximately 60% today, 
Since the introduction of the NCSP in 1990, the incidence rate of cervical cancer has fallen by approximately 60%. The death rate for cervical cancer has also continued to fall by approximately 60%. 

In 2008, the NCSP introduced new guidelines for cervical screening in accordance with new evidence for the management of women with abnormal smears. The Programme converted to the use of 100% LBC with adjunctive high risk HPV testing to manage women more effectively.

This session will focus on HPV testing, as well as highlight NCSP projects being undertaken to prepare for future change.

This presentation will cover the epidemiology and clinical significance of hearing loss in older adults as well as the presentation and management of hearing loss in the primary care setting. More specifically, this talk will attempt to dispel common myths and perceptions regarding hearing loss which is prevalent in nearly two-thirds of adults over 70 years.

Age-related hearing loss (ARHL) in older adults is often perceived as being an unfortunate but relatively inconsequential part of aging. However, the broader consequences of hearing loss for the health and functioning of older adults are now beginning to surface in epidemiologic studies. I will discuss recent epidemiologic research demonstrating that hearing loss is independently associated with poorer cognitive functioning, accelerated cognitive decline, an increased risk of incident dementia, and accelerated rates of brain atrophy as measured by MRI. Results from analyses of several large epidemiologic datasets including the National Health and Nutritional Examination Surveys, the Health Aging and Body Composition Study, and the Baltimore Longitudinal Study of Aging will be presented. Finally, I will discuss ongoing and planned studies to investigate the impact of current hearing rehabilitative interventions on delaying cognitive decline and dementia in older adults.

Supporting health professionals in busy practices to successfully design and deliver a patient-centred CVD risk assessment and management service We will be sharing success stories from around the country and introducing the Heart Foundation�s latest�s resources to support patient self-management.

Self Psychology in the 15 Minute Consult

Understanding self psychology will enhance the therapeutic dynamic of the doctor patient relationship. 

The work shop will provide us with a better understanding of what is going on between us and patients and how self psychology can be applied in the primary care setting through our conversation. Self psychology relies upon a therapeutic dialogue. We will use a conversational model and the analogy of the �playroom� to better understand what actually transpires in the course of any interaction between ourselves and patients.

Self psychology developed at a time when the traditional psychological modalities were failing. This coincided with an increase in maternal infant research and the development of the new psychotropic drugs.

We all have heart sink patients who frustrate us. Having a better understanding of the reasons why such patients continue to present, when and how they do, makes managing such (untreatable) patients much less stressful. A self psychology perspective can alter our interventions with all patients from distancing (through specialist referral and disengaging prescribing) to a more intimate constructive relationship based on empathic understanding. 

The aims of the workshop through illustrated case studies will be to 
� Understanding the concept of self
� To understand the significance of the self/selfobject matrix (cf: early mother infant environment) 
� To explore the values of intimacy and empathy
� To lighten the burden we all experience with our heart sink patients
� To look at the conversational model for implementing the ideas of self psychology and inter subjectivity

Most agree with the goal of the establishment of the unique Accident Compensation system in New Zealand. The legislation has been changed over the 30 years since its establishment but the basic principle remains the same. A universal no fault system that provides real benefits to people who are injured. 

So why are there still arguments about who, and what, gets covered? Are politics, administrative policy, or medical uncertainty to blame? The answer is not always simple because sometimes �it depends�. 

Start with the definition of accident and injury. Consider the specific facts of the case. Apply the legislation. Then do it again. If you don�t come to the same answer is it because there are no right or wrong answers? Well it might depend again.

Dr Margaret Macky will be speaking about the certainty of ACC�s decision making and how this is dependent on good information, consistent interpretation, and being able to show clinical accountability. Do you need to hear this� well it depends?

Type 2 diabetes is a progressive disease which needs progressive therapy for optimal glycaemic management and prevention of dreaded complications. This workshop aims to enhance knowledge and skills required of primary care practitioners for ongoing management of insulin therapy in the primary care. The participants would be expected to have had some prior experience in insulin treatment of type 2 diabetes patients and have attended the basic insulin initiation workshop. This workshop will try to address some commonly encountered practical management issues that may arise after a successful insulin initiation programme for type 2 diabetic patients.

In the prestatin era, the recommended management of lipid disorders involved characterising patients with dyslipidaemia according to complex classifications and recommending dietary and drug treatment according to a precise lipid diagnosis. The introduction of statins and impressive reductions in cardiovascular risk associated with this group of drugs have resulted in the recommendation that they be prescribed for all patients considered to be at moderate to high risk of cardiovascular disease. This lecture will consider whether statins are the most appropriate first line treatment for all patients with dyslipidaemia, the various statin preparations currently available, alternative treatments, combination of lipid therapy, side-effects of lipid modifying drugs and target lipid levels.

KiwiSaver for the employer and employee.

Kiwibank presentation will cover areas such as the importance of relationship banking, financial tools to enable managers to grow their business and key considerations, such as electronic banking. There will be a Q & A session covering any concerns or issues the mangers have over their current banking relationships.

From 7pm guests arrive: Otago Settlers Museum, Josephine Foyer. 
Background music on entry until 7:30pm
7:30pm Welcome speeches and guests invited to buffet table by table 
8:20pm Debate until approx 9:00pm 
"Why Doctors Would Beat Lawyers to the Summit of Everest"
Lawyer 1 David More
Lawyer 2 Sally McMillan
Doctor 1 Buzz Boothman-Burrell
Doctor 2 Kathryn Dalziel
Adjudicator: John Adams 
9:00pm Dessert buffet open 
9:15pm Band �Girl Friday� until 11:30pm

Any surgical procedure, no matter how minor, exposes the patient and the doctor to dangers. Basic safety measures in handling sharps and use of instruments, coupled with appropriate clinical knowledge and care, are the minimum requirement for anyone practising even the most minor surgical procedure. 

This session will begin with a safety framework, introduce basic surgical instruments and discuss their selection and use for minor surgery of the skin. In a hands-on interactive session, you will learn how to select and use appropriate needles and sutures, and perform incisions and excisions mindful of skin tension (Langers) lines. You will practise knot tying and simple suturing techniques, and consider post operative wound cares.

Covers transposition flap, advancement flap, and as time allows, full- thickness skin graft, dog ear repair, Z plasty. Previous attendance at the Basic Surgical Skills Course, or prior practical experience a pre-requisite for attendance.

He is a big picture thinker and has particular skills in leading change, and motivating and mobilising others to be part of the transformation. David is passionate about health and what�s possible when people grasp the vision and work collectively for the greater good. The achievements of the Canterbury Health System are testimony to his leadership.

Originally from Canterbury, David has worked in both the private and public sectors, in NZ and the UK. He has also led and been involved on a number of national groups ranging from workforce negotiations to CEO alliances.

Recent experiences in Canterbury have shown David is adept at managing large teams through a crisis and developing and implementing robust recovery plans.

Healthline is now 12 years old and has taken 3 million calls. In 2013 the contract for providing Healthline goes again to tender, and we predict the service will expand and diversify. Its aims will be the same�access to health advice for those who find access to primary care difficult, and direction to the lowest, safest level of care, avoiding unnecessary presentations to the GP or emergency department. It will remain a telephone triage and advice line, available 24 x 7 to all New Zealanders; but it will likely expand to provide advice on medicines from a pharmacy line, a general practice after hours triage service and information on cost and access to services. Integration with other health lines (poisons, immunisation information, smoking cessation, depression, gambling lines) is also under discussion. Access to triage and advice by telephone will continue, but online triage tools are likely to be added � symptom checkers from home computers and handheld devices, with links to Healthline; texting, SMS, chat lines, video consulting are all in the future mix�along, of course, with the flexibility to adopt new information technologies as they emerge. Secondary triage for ambulance and liaison with general practice will become requirements. All of this will require safe and effective decision support software, and a robust clinical governance system which we will demonstrate.

Musculoskeletal system complaints are common in General Practice. In this workshop a case-based approach will to be used to help attendees formulate imaging strategies that will enhance diagnosis and management of conditions in the upper and lower limbs and spine, keeping in mind financial and referral constraints.

This session will provide GPs with an update from an experienced sports physician who was a GP in an earlier life. I will provide my approach to these four issues in a practical workshop setting with ample opportunity for questions and feedback.

Bad backs
Most of these are simple mechanical in nature, but you will learn the features that enable you to distinguish the atypical variants, i.e. complex mechanical, radiculopathy, inflammatory back pain, spinal stenosis, a non-spinal cause and those with a significant non-organic component. I will then outline a practical management plan for each of these options. Be on the lookout for �red flags�, e.g. weight loss, previous malignancy, etc.

Tennis elbow 
This session will concentrate on the typical cause of tennis elbow symptoms, which is tendinopathy of the extensor carpi radialis brevis muscle. I will outline the usual recommended evidence-based treatment for this condition. However, I will also touch on other conditions which can mimic tennis elbow including tendon tears, nerve entrapments and referred pain from the neck.

Difficult ankle sprains
The third part of the workshop will concentrate on difficult ankle sprains. Most ankle sprains get better in three to four weeks and I will go through the major things to suspect if the person is not improving as expected. These include lateral gutter irritation, posterior impingement, functional instability, associated fractures around the ankle, rupture of major ligaments, tendon problems and complex regional pain syndrome.

Practical help for OA
The fourth part of the workshop should enable you to provide practical help for your patients with OA. This revolves around activity modification, well-cushioned footwear, orthotics, judicious use of NSAID or cox-2 agents plus cortisone. There will also be comment on those patients you should consider referring for surgery.

For each of these topics I will try and give insight into a couple of things that GPs could do better, based on my experience both as a GP and later as a specialist.

This workshop will cover the practicalities of injecting joints, concentrating on the knee, lateral elbow and subacromial space, that are the most accessible site for GP injections. For those interested in more advanced techniques I will cover the AC joint of the shoulder, medial elbow, lateral hip and sacroiliac joint.

We all need to be aware that injections are not a cure-all and they work as part of a comprehensive rehabilitation programme. I will outline my strategy for post-injection advice and my own patient advice sheet will be available off the website for this conference.

I will also discuss the issue of clinical landmark versus ultrasound guidance for injections, as it is my belief that a lot more injections are being done under ultrasound guidance than is clinically necessary. I believe we should be applying technology selectively as this should provide the greatest benefit for patients for a given quantum of health expenditure. Nevertheless, there are a few injections, e.g. those for tendons in the hands or feet, which are in my view most appropriately performed via ultrasound guidance for a variety of reasons. This also applies to injections performed for hypervascular tendinopathy affecting the achilles or patella tendon.

In essence, the suitability of a particular joint for injection depends on the size of the entry portal, the accessibility of the structure, i.e. superficial versus deep, and your own confidence with a given injection technique.

HANDOUT: Local Corticosteroid Injections

In youth, physical training is largely geared towards maximising performance. The typical young athlete is goal-oriented and competitive, although even those playing social sport are happy to be recognised as the MVP in their weekly club game. Those with lofty ambitions may aspire to be an All Black, Silver Fern or Olympian, but after a year or two in any particular sport we pretty soon find our own level.

The youthful body is virtually bulletproof, and virtually the only issues young athletes have to deal with are injury-related or possibly a hangover from binge drinking. The environment is very much competition-focused and people will train in virtually any weather conditions.

Contrast that with middle age, where most of us are now. The perspective we have is of preserving what functional capacity we have and minimising weight gain from the impressive dinners cooked up by our partner. Ambitions are significantly less lofty, e.g. getting around the golf course without a cart, and enjoying tramping or walking with friends.

The middle aged exerciser needs to be cognisant of pathology they may have accumulated in the form of early arthritis, ischaemic heart disease, type 2 diabetes or hyperlipidaemia. Exercise can have a positive effect on all of these things; the focus is much more around positive experiences and smelling the grass. We middle agers prefer it not to be too cold, hot or wet, and if the exercise bout is followed by a social beer or wine, that�s all good, too. If you're a man, it may even stave off your need to use Viagra.

In essence, we middle agers are trying to slow the inevitable decline of organ system function from its peak in early adult life. Tissue function declines by about 10% per decade, but if we can reduce this by half with regular exercise then 60 really can be the new 45.

Today�s session will cover four topics:

1. Asthma drugs where there therapeutic recommendations are largely tempered by requirements for Therapeutic Use Exemption (TUEs). My recommendations include the following:
1. Beta 2 agonists, salbutamol 
2. Inhaled corticosteroids, Fluticasone 
3. Long acting beta agonists (LABA) Salmeterol 
4. Cromoglycate, Tilade

Other beta 2 agonists or inhaled steroids need a positive bronchial provocation test before they can be administered to athletes who are subject to drug testing requirements. For the busy GP, if you have an athlete who is talented and on the way up, the sensible thing is to prescribe from within this relatively limited repertoire, as this will save you and the athlete much time and angst later in complying with Therapeutic Use Exemption requirements.

A short course of oral corticosteroid injections require objective verification of lung function, e.g. via spirometry, and preferably involvement of a second clinician, e.g. your local hospital or respiratory specialist, before a TUE can be granted. Consult with Drug Free Sport New Zealand (ph 0800 DRUG FREE) before prescribing any corticosteroids to athletes who are subject to drug testing. In an emergency situation, treat the patient as you normally would, and worry about doping issues when the patient is better!

2. Probenecid
The action of this drug is to block renal excretion of certain drugs and metabolites. Its therapeutic use is to block excretion of penicillin and thereby raise the blood level to help treat acute infections. However, it can also block the excretion of banned substances so they will not show up in a urine test. For this reason it is on the banned drug list. Many protocols for management of acute infections in A & M clinics include the use of probenecid. Athletes subject to drug testing should not receive probenecid, but rather consider doubling the dose of penicillin to achieve the same clinical affect without having to utilise probenecid.

3. Supplements/anti-aging products, e.g. DHEA
This is a minefield and all athletes need to be aware that when taking any supplement they are essentially taking the manufacturer on trust. DO NOT assume any responsibility for checking the legality or otherwise of any supplement; this is not your role, and you do not want to be implicated in any later fallout following an adverse finding on drug testing. Essentially, the athlete is taking the manufacturer on trust, and this needs to be emphasised again and again. Too many athletes are popping too many supplements of dubious value to their health and wellbeing in the expectation that their performance will be improved.

4. Blood testing to monitor the health of a patient who says they are taking androgenic anabolic steroids
You may receive an occasional approach from a bodybuilder or powerlifter in this scenario. My attitude is why would you bother getting involved? You could be accused of aiding and abetting a corrupt practice. In my opinion, we do not have any duty of care to such individuals. It is their choice to take androgenic anabolic steroids and they have to accept the risks involved. Generally these agents are obtained via underground networks through gyms or off the internet. These agents have very little place in mainstream medicine. For the rare individual with an endocrine disorder or a person with aplastic anaemia who is not a candidate for a bone marrow transplant, they can be monitored by the relevant specialist in conjunction with their GP.

The above four scenarios are those of most relevance to practice nurses, but I will be happy to discuss other scenarios and general doping issues at this session.

To quote from the most admired medical textbook ever, there is �no body cavity that cannot be accessed with a 14 gauge Angiocath and a good strong arm.� To paraphrase, �there are few foot problems that cannot be helped with use of a little orthopaedic felt�.

Orthopaedic felt can have both diagnostic and therapeutic benefits, and relies on the fact that most foot pain is mechanical. Furthermore, for many shoes, especially women�s, fashion rather than comfort dictates the shape of the shoe.

I will go through common issues that you can help with appropriate use of orthopaedic felt. These include flat foot deformity, medial shin pain (periostitis) and high arched feet.

The aim of this workshop is not to denigrate the very good work done by our podiatry colleagues, but rather to empower GPs to provide relief for their patients within the space of a consultation, and also to sometimes provide useful information to the podiatrist which can help in later provision of custom-moulded devices.

ACC receives many claims for chronic toxicity. Most are from people who have worked with pesticides, solvents, heavy metals or petrochemicals but almost any substance, pungent or otherwise, can be implicated. Claims are also received from those alleging that they have been poisoned by involuntary chemical exposures independent of work. Injuries claimed for include various types of cancers, neurotoxicity, skin diseases, chronic fatigue syndrome, multiple chemical sensitivities and a wide range of symptoms.

Investigating these claims can be difficult because exposure is often historical, in many cases there is no workplace to assess, exposure data are lacking, multiple confounders exist and there may be little in the way of relevant toxicological information on the substances concerned. In addition, many claims are underpinned by a sense of grievance or entitlement. 
In 1998 ACC set up a Toxicology Panel to assess these cases and provide advice on cover and management. In this workshop two Panel members will take you through the evaluation process using selected case studies to illustrate the variety of claims seen, the range of issues to be dealt with and the manner in which decisions are reached. 

As the starting point for most workplace poisoning claims the GP is well placed to advise the patient on the chances of success. It is hoped that the workshop will serve not only to demystify the process but also to help doctors feel less pressured to lodge a claim just because the patient wishes it.

From 7pm guests arrive: Otago Settlers Museum, Josephine Foyer. 
Background music on entry until 7:30pm
7:30pm Welcome speeches and guests invited to buffet table by table 
8:20pm Debate until approx 9:00pm 
"Why Doctors Would Beat Lawyers to the Summit of Everest"
Lawyer 1 David More
Lawyer 2 Sally McMillan
Doctor 1 Buzz Boothman-Burrell
Doctor 2 Kathryn Dalziel
Adjudicator: John Adams 
9:00pm Dessert buffet open 
9:15pm Band �Girl Friday� until 11:30pm

What don�t you know you don�t know � maybe we can help?

ACC Treatment Injury (TI) Centre, Lower Hutt, New Zealand

Did you know:

� In 2005 the Accident Compensation Act 2001 was amended
� ACC no longer needs to establish medical error to cover a treatment injury
� ACC receives over 5,000 treatment injury claims per annum

In which case do you know:
� When/how to lodge a TI claim
� What kinds of events involving General Practitioners are resulting in injuries
� How the legislation works
� If ACC can report you to the Medical Council

If you don�t know the answers Chris and Brendan invite you to join them for a discussion about all things Treatment Injury. At the end of the session we hope that you will understand more about TI and the benefits of lodging claims for patients.

Treatment of DVT: something old, something new, something borrowed�.

This talk aims to cover �what�s new� in the rapidly expanding area of anticoagulant options with highlights of their uses, strengths and potential pitfalls. It will touch on the guidelines on duration of anticoagulation, d-dimer assessment and special circumstances such as pregnancy and cancer-related thrombosis. By the end of the session I would hope you pick up a few useful learning points on practical issues faced by GPs every day.

We will cover the diagnosis of benign and malignant skin lesions including the basics of dermoscopy using modified pattern analysis. This will be less hard work if you�ve read a book or done an online course first. 

The main thing is to use your dermatoscope frequently so you become familiar with the range of appearances of benign lesions. The aim of the course is for you to become more confident in recognising patterns of lines, dots, clods and structureless areas, thus reducing the numbers of unnecessary excisions of entirely benign lesions. Malignant skin lesions lack these patterns.

Those with difficulty distinguishing red-green colours may be challenged by dermoscopic subtleties and will have to depend on identification of structures. Dermoscopy is more powerful if you routinely photograph lesions of concern, particularly those you plan to excise, follow up or refer.

This workshop will go over the evidence for why all general practitioners should be prescribing exercise for health for all their patients on a daily basis. Basic guidelines for exercise prescription will be presented and the nuts and bolts of how to do this at the coalface will be discussed. The pitfalls and case examples will be used to illustrate the workshop.

It's nearly 40 years since it was shown that tendons become degenerate not inflamed. It's 15 years since tendonopathy was shown to respond to painful exercise not rest. Since then a few new treatments have come and gone, some remain trendy and are now heading towards being disproven and for many treatment of tendonopathy remains a mystery. This workshop will give a brief history of the treatments for tendonopathies and outline an intervention programme for each of the common varieties including exercise description, drug prescription and other interventions.

�We [doctors] are in danger of becoming mere indentured labourers � where control is shifted into the hands of those with limited knowledge of [medicine] � We progressively see a situation where those outside the profession are regulating the profession and we are in danger of creating an environment of defensive medicine � The best safeguard for patient care is the professional contract between doctor and patient.� (Ross Blair, 2003)

What is the situation a decade later? Are primary care doctors so over-burdened and over-regulated that professionalism has been eroded? How should general practitioners respond to growing pressure to report more data and undergo regular competence checks?

Richard�s special interests include:
� Laparoscopic colorectal surgery 
� Pelvic floor and anorectal disorders, including haemorrhoids, fistulas, rectocele and rectal prolapse.
� Colonoscopy and colonoscopy standards
� Surgical education and skills training
� Governance and standards

Any surgical procedure, no matter how minor, exposes the patient and the doctor to dangers. Basic safety measures in handling sharps and use of instruments, coupled with appropriate clinical knowledge and care, are the minimum requirement for anyone practising even the most minor surgical procedure. 

This session will begin with a safety framework, introduce basic surgical instruments and discuss their selection and use for minor surgery of the skin. In a hands-on interactive session, you will learn how to select and use appropriate needles and sutures, and perform incisions and excisions mindful of skin tension (Langers) lines. You will practise knot tying and simple suturing techniques, and consider post operative wound cares.

Covers transposition flap, advancement flap, and as time allows, full- thickness skin graft, dog ear repair, Z plasty. Previous attendance at the Basic Surgical Skills Course, or prior practical experience a pre-requisite for attendance.

Pelvic Floor Disorders are a common, under-recognised cause of anorectal and bowel dysfunction including constipation, incontinence, pain and prolapse. Intact and functioning nerves, muscles and connective tissue are necessary for normal function. The anatomy of the pelvic floor makes it vulnerable to damage during childbirth or from straining. Variability in the quality of connective tissue means that pelvic floor failure can occur in the absence of trauma. 

A careful, targeted history often provides the basis of a diagnosis of pelvic floor dysfunction, and physical examination will often confirm the diagnosis. The most useful investigation is a Dynamic Pelvic Floor MRI. 

Accurate diagnosis and an understanding of the pathophysiology are the key to planning treatment. Therapeutic options range from dietary manipulation, specialised pelvic floor physiotherapy, or biofeedback to a number of specialised surgical procedures.

This workshop will give an overview of the subject and provide a framework to guide your assessment, decision-making and advice to patients presenting with pelvic floor disorders.

Colorectal cancer remains the most common non-cutaneous cancer affecting New Zealanders. With expanding understanding of colorectal cancer genetics, high risk individuals can be identified and offered intensive screening. The first screening takes place in General Practice with a careful family history, researched and verified as necessary. The NZ Familial Gastrointestinal Cancer Service will assist with pedigree checking and arrange genetic testing when appropriate. Families with Familial Adenomatous Polyposis and Lynch syndrome need close colonoscopic surveillance, if not prophylactic resection. However, with such a high population incidence, a case can be made for screening not just at-risk individuals, but the entire population. The best way to do this is still open to debate. Overseas countries, including Australia, have introduced national screening programs for colorectal cancer, largely implementing faecal occult blood testing. A pilot study is currently underway in Waitemata. 

Increasingly genetics is guiding treatment of colorectal cancer. Response to chemotherapy varies with different phenotypes �for example tumours with microsatellite instability do not respond to 5-Fluorouracil.

This session will discuss the clinical implications of contemporary understanding of colorectal cancer genetics and current screening guidelines.

Healthline is now 12 years old and has taken 3 million calls. In 2013 the contract for providing Healthline goes again to tender, and we predict the service will expand and diversify. Its aims will be the same�access to health advice for those who find access to primary care difficult, and direction to the lowest, safest level of care, avoiding unnecessary presentations to the GP or emergency department. It will remain a telephone triage and advice line, available 24 x 7 to all New Zealanders; but it will likely expand to provide advice on medicines from a pharmacy line, a general practice after hours triage service and information on cost and access to services. Integration with other health lines (poisons, immunisation information, smoking cessation, depression, gambling lines) is also under discussion. Access to triage and advice by telephone will continue, but online triage tools are likely to be added � symptom checkers from home computers and handheld devices, with links to Healthline; texting, SMS, chat lines, video consulting are all in the future mix�along, of course, with the flexibility to adopt new information technologies as they emerge. Secondary triage for ambulance and liaison with general practice will become requirements. All of this will require safe and effective decision support software, and a robust clinical governance system which we will demonstrate.

There are some recurring scenarios that put practices at risk, such as managing the interface between complementary therapists and your practice, dealing with parents disputing care arrangements for their children, and children disputing care arrangements for their parents to name but a few. Other scenarios include:

� managing the rude/poor communication skills doctor � i.e. the "I'm never going to see that doctor again..." comments at the front desk; 
� managing serious adverse outcomes that might lead to a complaint; 
� addressing levels of responsibility if health professionals are thought to be under-performing (just what does statutory responsibility actually mean?); and 
� managing inappropriate behaviour in the workplace from a practice manager's perspective.

This practical session will allow practice managers to bring their concerns for discussion about appropriate responses within the legal framework as well as talking about solutions to issues that have caused practice managers, doctors and other health professionals to seek help through the Medicus helpline.

To the Tribunal and � fingers crossed � Back again
In this practical and at times humorous workshop, participants will take on the roles of responder to a complaint, adviser on the complaint and prosecutor cross-examining on the written complaint.

A case scenario will be put to participants and a response prepared that, after consideration and critiquing by participants as adviser, will then be the subject of cross examination in a mock trial-type setting.

The aim of this Medicus sponsored workshop will be to talk about practical tips to help your practice avoid complaints, respond to complaints, and avoid the pitfalls of responding in a way that could provide unnecessary ammunition for lawyers who see the world very differently from health professionals. Last year�s work shop by this team was fully subscribed so early enrolment is encouraged.

Perhaps the most critical issue in the initial assessment of a patient presenting with symptoms of arthritis is to determine whether or not the symptoms result from inflammation. This is because inflammatory problems usually ultimately stem from inappropriate immune system activity and require immunosuppressive treatment, an approach that is both ineffective, and potentially harmful, in non-inflammatory conditions.

The principal features that distinguish inflammatory from non-inflammatory disease and common pitfalls are discussed first.

Then the main types of inflammatory arthritis, their clinical features and initial management are discussed. The emphasis is on pragmatism, and the most commonly encountered entities. The presentation aims to cover the most common questions asked by non-rheumatologists to rheumatologists.

Although questionnaire response with scoring is an excellent resource in making an accurate diagnosis of COPD, the gold standard for diagnosis is spirometry. This can assess the severity of the COPD and can distinguish between restrictive, and obstructive lung disease. It further distinguishes between reversible obstruction (asthma) and non reversible (COPD). 

The workshop will cover spirometry technique, and assessment. 

Spirometry is a valuable tool in the diagnosis and management of a number of respiratory conditions. However it�s value is only as good as its accuracy and accuracy depends almost entirely on technique. This workshop will cover tips, traps and tricks to obtain good outcomes with patients.

Early Childhood Council CEO, Peter Reynolds, discusses the wider determinants of health and educational outcomes, by discussing health and early childhood education contexts in New Zealand.

The underlying premise of this workshop is to discuss the opportunities for the growing partnership between early childhood education and primary care, including the implications of key research such as:

�My taskforce concluded that the evidence is compelling that to promote non-cognitive development in early years is far more effective than attempts at remediation of conduct disorders later in the life course..� 

(Improving the Transition � Reducing Social and Psychological Morbidity During Adolescence � A report from the Prime Minister�s Chief Science Advisor, Professor Sir Peter Gluckman)

Mr Reynolds� plenary workshops will discuss; 

� the evidence supporting quality ECE provision in New Zealand, 
� how health and education are inextricably linked, 
� why addressing the wider determinants of health and education outcomes are important, 
� Government priorities such as the Government�s welfare reforms and 98%, participation target in ECE by 2016,
� what General Practice can do in this space,

There will be an opportunity for participants to ask questions.

To the Tribunal and � fingers crossed � Back again
In this practical and at times humorous workshop, participants will take on the roles of responder to a complaint, adviser on the complaint and prosecutor cross-examining on the written complaint.

A case scenario will be put to participants and a response prepared that, after consideration and critiquing by participants as adviser, will then be the subject of cross examination in a mock trial-type setting.

The aim of this Medicus sponsored workshop will be to talk about practical tips to help your practice avoid complaints, respond to complaints, and avoid the pitfalls of responding in a way that could provide unnecessary ammunition for lawyers who see the world very differently from health professionals. Last year�s work shop by this team was fully subscribed so early enrolment is encouraged.

Insomnia affects about a third of the community and is a common cause of consultation in primary health care. If it is not treated, it can lead to serious health problems. The Goodfellow Insomnia toolkit simplifies the process of diagnosing and treating sleep problems in adults and children as well as encourage professional discussion about the management of primary insomnia. The focus is on patients who present with an identified sleep problem, rather than patients who may have a sleep problem as a result of some other morbidity. Learners engage with evidenced based research and apply this learning to virtual patient case studies. The University of Auckland and Perrin Rowland from the Goodfellow Unit will present this toolkit and demonstrate the interactivity of its assessment process.

The content of the toolkit has been developed by Dr Karen Falloon with input from Dr Bruce Arroll and based on the original work of Falloon, Arroll and Fernando. The toolkit has been created by the Goodfellow Unit at the University of Auckland. This was funded in part by the Auckland Faculty Board, Royal New Zealand College of General Practitioners.

Rapid depression assessment and rapid treatment and initiation of prophyllaxis for gout

Rapid depression assessment
There are two screening questions for depression. They have to do with current mood and enojoyment and pleasure in life. If these two questions are both negative the patient almost certainly does not have depression. If one or the other is positive a longer questionnnaire, such as the PHQ-9, needs to done to sort out the false positive tests from the true positive tests.

Rapid treatment and initiation of prophyllaxis for gout. 
It is difficult to get patient back to the clinic after an acute attack of gout for prophyllactic treatment. A rapid treatment for gout is discussed using oral prednisone (having ruled out infection) along with blister packs containing allopurinal and colchicine. The prednisone is given for 2 weeks and the allopurinol for 3 months in increasing doses and then indefinitely.The dose is titrated against the serum uric acid level. The colchicine needs to be continued for another 3 months (total of 6 months). The use of blister packs to ensure that the simplest regimen of treatment is available will also be discussed. Testimonials from grateful patients will be discussed.

Reference. 
Arroll B. How to treat gout and prevent it in 7 minutes NZ Doctor 27 feb 2013 page 23

This will be a session with a lot of interaction between participants and me.

There will be 1 to 4 case histories to discuss and opportunity to bring your own problem cases along for discussion.

At the end of the session I expect you to better understand the difference between a thickening and a lump and to know how to approach both of these so as to rule out malignancy.

This is also an interactive session with a radiologist and me.

Your own problem cases can also be discussed if you wish to bring them along.

An overall cover of how we treat breast cancer now looking at surgery and radiotherapy, chemotherapy ,hormonal and herceptin.

A brief review of what is new such as partial breast radiotherapy and new surgical techniques if time allows.

One case will be about prophylactic mastectomy and genetics to look at how you can assess your patients for this risk.

With so many types of Medical Equipment in the market today each with their own distinctive applications and supporting technology, our reliance upon these devices have changed the way we operate on a daily basis. Medical Equipment like any asset depreciates with time and with it brings Maintenance, Safety and Performance Issues. Regardless of its age and how technologically advanced your Equipment maybe, there is always associated potential hazards to Patients, End-Users as well as Service Personnel if your Medical Equipment is not Maintained or Serviced Regularly. If your Medical Equipment is regularly maintained it will prolong the life span of the device as well as eliminate the risk of an inaccurate or premature failed system in the future.
The importance of having a good Preventative Maintenance Program for your Medical Equipment at your practice is an important part of Safety Management and an essential part of Accreditation. Some points that will be addressed during the presentation include: 
Electrical Hazards associated with Electrical Medical Equipment
Other types of Hazards associated with Medical Equipment
What is Performance Verification Testing?
What is Electrical Safety Testing? 
What is Acceptance Testing?
WOF approach
In-house Repairs Management System

The presentation will be from a series of actual recent referrals to the CDHB gynae department, highlighting various aspects of common gynae problems with a quickfire series of points for practice. 

Audience participation is mandatory and constructive heckling is encouraged!

Despite a marked reduction in coronary heart disease mortality in New Zealand over recent decades, a �new wave� of coronary disease is threatening which is closely related to obesity and diabetes and more prevalent in disadvantaged people. To counter this we need to more intensively advocate for environmental change and healthy public policy, promote educational approaches in communities and schools, support primary care with the assessment and management of cardiovascular risk in their adult populations and ensure quality standards and equity of access for people who require clinical care.

The NZ Health Strategy 2000 suggested that Primary Health Organisations might take care of their practice populations through enhanced preventive approaches. Implementation of the Guidelines for Cardiovascular Risk Assessment and Management (2003) has progressed steadily through primary care but has essentially remained opportunistic. The recent introduction of the new health target �More Heart Health and Diabetes Checks�, whilst clearly understood as a political expedient, does provide a time-limited opportunity to progress a systematic approach which could provide large benefits for many people, and particularly the more disadvantaged, in a relatively short period of time. 

It is important to consider that the entire adult population is �at risk� and that the process does not represent reliable screening for disease. Most clinical events will still occur in those at low or medium risk who are the majority of the population. The threshold for �high risk� intervention needs to be adjusted, particularly for age, with clinical judgement and informed patient preference factored in. Risk assessment alone is of little value without support for appropriate management. There are a number of resources now available to assist health professionals through e-learning modules and also patients with self- management programmes.
The challenge for primary care is to realise this opportunity for heart health improvement amongst the many competing demands in the sector. Primary care is in the keystone position to systematically and effectively merge population and individual health improvement for which purpose the new target is a timely incentive.

Burn injuries are among the most common and complex of all medical conditions. 1% of the population of Australia and New Zealand (220,000) suffer from a burn injury each year; 10% will require hospitalization (Australia and New Zealand Burn Association, 2006, EMSB course manual). The remaining 90% are management in the community. 

Some burn wounds can be challenging to cost-effectively get healed especially with limited resources. 

The Evidence-based Best Practice Guideline for Management of Burns and Scalds in Primary Care (2007) is an in-depth guideline which is meant to �form the basis for decision-making by the health care practitioner in discussion with an individual with a burn injury in developing an individualised care plan�. It certainly is an in-depth document but how helpful is it when 9 different generic wound care products are suggested to be used on the burn wound? It is reasonable to state that such a range can lead to confusion especially for the beginning health care practitioner. Some of the products are expensive when cheaper options would be just as effective.

I have worked at Waikato Hospital in the Plastic Surgery and Burns ward for 15 years; 14 of them as the charge nurse. I am now employed as a clinical nurse specialist (CNS) for Plastic Surgery which includes the Waikato Regional Burn Unit. This role means I follow the patient care continuum � I can work beyond the walls of the hospital. I am passionate about burn care so much so that I did my Masters thesis in trying to get consistency in burn care.

In this presentation I will discuss briefly discuss burn care, especially the first aid care that should be given as soon as possible after the burn occurs because it does make a difference to the outcome; which patients should be referred to hospital and which can be safely cared for in the community. I will discuss what I have found to be effective dressings but would appreciate findings and discussion from GP�s and Practice Nurses because they manage the 
90% of burn injuries that occur in the community who don�t get admitted to hospital.

There is an increasing need for travel health professionals to include safety and security issues on a checklist of itinerary items to be discussed at initial pre-travel consultation. So where does one start? 

The short answer is to start from one�s own experience, layer this with information and develop a plan for consultation that the intending traveller will understand and be prepared to implement. 

There are many factors to ensuring secure travel and pre-travel counselling is essential and assessment of potential risk requires a global approach, looking at: 
1. Health surveillance whilst travelling
2. Personal Accidents and Injury
3. Violence
4. Societal Transport Accidents (Air and Motor)
5. Societal Disaster
6. Swimming
7. Drugs
8. Terrorism
9. Bioterrorism
10. Pre-travel Planning 

First thing to do, to secure traveller comfort, is to identify and defuse any possible stress of travel. This needs to be developed at the first, and often only, consultation. All those travelling overseas for short or long periods of time need to have some understanding of how to personally protect themselves, physically and psychological, whilst they travel. 

Travellers being encouraged to do some personal research into the intended regions of travel, can only be encouraged. The assessment of NON-PERSONAL ISSUES of travel, allow for a better traveller equipped to make a journey stress-free and more comfortable by planning a �deal with� routine of issues beyond their control: e.g. physical terrorism, involvement with crime, Biosecurity issues and societal disasters.

It is hugely important that an attempt be made to discuss the �safety and security� of travel and the primary care practitioner needs to either do this themselves or the traveller needs be referred to those that will take the time to discuss this important pre-travel dynamic. More and more global travel is filled with destabilisers (like safety and security issues) that can destroy a travel experience. Should this be so then the thrill of travel is gone. Often having done so, it is hard to restore lost enthusiasm.

So you have that terrible traveller. The Friday night, last one in the surgery before you go home. They are off on an exotic holiday and you are stuck in a wintery surgery! What are you going to tell them. This is a session that looks at the key guidelines for advising such a traveller.

Going to Galapagos and Peru? What are the health risks? Find out the risks of travelling to this beguiling part of the world in this session that focuses on travel to the region where most seniors are going to at the moment.

General Practice is well placed to contribute in a number of ways to reducing the relatively high rates of suicide in New Zealand . This session will review how to assess and manage patients at risk of completing suicide. It will also explore the initiatives that practices can support to build the resilience of their patients and their families/whanau and the wider community. 

This will be an interactive session for Practice Nurses to further develop their knowledge and skills when working with people who present with mental health and or addiction problems.

Common mental health problems will be discussed and suggestions for improving engagement and recovery will be offered.

Practice Nurses will have an opportunity to discuss relevant cases if time permits.

The Rural Medical Immersion Programme (RMIP) was established in 2007 as an alternate curriculum for a select number of fifth year medical students whose training takes place for the whole academic year, in an apprentice like role, in a rural setting. General Practice, rural hospitals and provincial hospitals offer good opportunities for delivering generalist teaching in all disciplines of health providers. Such teaching takes place in small group tutorials or 1 on 1 at the bedside and during the progress of clinics. Students of the RMIP learn from general practitioners and hospital medical staff on the job, learning from the teacher as a role model and facilitator.

The incidence of some cancers has been associated with exposure to ultraviolet radiation. The most consistent association is with melanoma. However, low levels of Vitamin D have also been linked to some bone and muscle diseases and possibly colorectal cancer. This has resulted in speculation that sunscreen use and sun avoidance behaviours resulting in low levels of Vitamin D may increase the risk of some diseases. The evidence for and against these associations will be presented for discussion.

This workshop will cover 4 main ideas.
1. What is the epidemiology of melanoma in New Zealand, how has it been changing, and what does it mean?
2. Who is at high risk? The measurement of individual absolute risk of melanoma. 
3. And even if we estimate individual melanoma risk would it make any difference to the outcomes? 
4. How does this risk compare with other diseases in New Zealand?

The scalpel is our traditional weapon of choice, but there are other choices out there This talk explores the use of electrosurgery in the GP office and Skin Cancer theatre.

Early Childhood Council, Project Manager for �Partnering with Parents�, Laree Taula, introduces a project that demonstrates the growing role of early childhood centres as providers of not only education and care for children, but also as places of commonality and support for families. This will become increasingly so as the Government moves towards its target of 98% of all children by 2016 having had some form of early childhood education by the time they start school. 

Partnering with Parents is a collaborative initiative between the Early Childhood Council, Plunket, and the Ministry of Social Development. The initiative aims to build healthy and reciprocal relationships between parents, early childhood education providers and health professionals, to better support pre-school-aged children. The initiative draws on current parenting material and research about the importance of working with families for positive lifelong educational and health outcomes.

Partnering with Parents utilises the early childhood education network of services to bring together parents, health professionals and others to answer the question: �How can we best work together to support the children we all care for?� 

The long term goal is that �Partnering with Parents� will be an adaptable package available to all early childhood education providers in New Zealand.

This workshop will cover the diagnosis and management of common orthopaedic emergencies seen by GP�s in urban and rural practice including fractures, dislocations, spine trauma, infection, ligament and tendon injuries etc. There will be the opportunity for interactive discussion of a number of clinical cases to illustrate best practice in relation to this topic.

This workshop is intended for GP's who want to refresh their fracture management skills and will cover the assessment of simple fractures of the upper and lower limbs including Xray interpretation and plaster/ splint application. There will be opportunity to practice cast application and simple splinting techniques.

The aetiology proposed for the development of chronic cerebrospinal venous insufficiency (CCSVI) associated with multiple sclerosis(MS) has been the presence of congenital truncular venous malformations. However this hypothesis is not consistent with the epidemiology or geographical incidence of MS and is not consistent with many of the ultrasonographic or radiographical findings of the venous disturbances found in MS patients. Never-the-less the probability of a venous aetiology of MS remains strong based on evidence accumulated from the time the disorder was first described. 

Epidemiological and geographical findings of prevalence of MS indicate the involvement of an infective agent. This presentation of the venous pathology associated with MS describes a theory that the pathogenesis of the venous disease could be initiated by a respiratory infective agent such as Chlamydophila pneumonia, which causes a specific chronic persistent phlebitis and venulitis affecting the cerebrospinal venous system. Secondary spread of the agent would initially be via the lymphatic system to specifically involve the azygos, internal jugular and vertebral veins. The theory proposes mechanisms by which an infective venous vasculitis could result in the specific neural damage, metabolic, immunological and vascular effects observed in MS. The theory presented is consistent with many of the known facts of MS pathogenesis and therefore provides a framework for further research into a venous aetiology for the disease.

If MS does result from a chronic infective venulitis rather than a syndrome involving congenital truncular venous malformations, then additional therapies to the currently used venoplasties will be required to optimize results.

This workshop will outline the principles of when venoplasty is indicated for treating stenoses of the internal jugular and azygos veins as well as describing the combined antibiotic protocol used to manage chronic persistent chlamydophila pneumonia phlebitis and venulitis affecting the cerebrospinal circulation.

The management of varicose veins has progressed significantly in the past 20 years due primarily to the universal use of duplex ultrasound to assess and monitor treatment progress, and the development of advanced minimally invasive techniques that rely on new technologies such as endovenous laser and radio-frequency (RF). These are usually combined with either ultrasound-guided foam sclerotherapy or mini-phlebectomies depending on the practitioner�s training, skills, and preferences. As a result classical high ligation and saphenous stripping is rarely performed today, due to a higher incidence of adverse effects, longer recovery times and inferior long-term results.

The classical concept of compression therapy for patients with CVI and PTS of the lower extremities recommends starting with an acute therapy phase, consisting of firm bandages, and then transferring to a maintenance phase, in which the extremity should be kept free from oedema using compression stockings.

The logic of this approach is related to the following practical problems:
1. Compression stockings prescribed for a swollen leg rapidly lose their fit and need to be newly prescribed repeatedly
2. Bandages require trained staff to apply (or provide training to a carer) and are often a single use imposing a considerable economic burden.

In practice, for prevention and treatment of oedema and less severe CVI symptoms, compression stockings are effective and usually sufficient. However for the treatment of patients with chronic venous hypertension (PTS), it is necessary to achieve interface pressures that approach the level of ambulatory venous hypertension during walking, but that are comfortably tolerated when lying down. These preconditions may be fulfilled by multilayer bandages applied with a resting pressure of 50mmHg or more.

When prescribing compression for CVI and PTS, in addition to assessment of the deep and superficial venous, it is also necessary to assess the lower extremity arterial pressures as well as the lymphatic system, as these will influence management.

�Keys to unlock the mysteries of tricky consultations?� 

What allows you as a doctor to swiftly differentiate between the dangerously sick child in need of emergency transport, and the one who is crying loudly but merely upset?

Your training has taught you to look for some quite specific signs and symptoms. 
However, patients also provide other significant information that we don�t always pick up on. In the patient-doctor relationship this information can make the difference between frustration and conflict or good communication and concordance.

Every patient, regardless of age, provides clues as to what makes them tick. Clues that give us useful information to better understand them and their story - if only we know exactly what to look and listen for. Your awareness of these clues makes the process of diagnosis and management much easier for you, as the healthcare professional, than for the worried and less informed parent.

Drawing from the field of neurolinguistic programming, along with the learning and processing models of Myers-Briggs, Kolb and McCarthy, Dr Nigel Thompson will share simple concepts and tools to quickly transform your daily consulting. 

This seminar presents strategies to maximise your chances of success � strategies that are both easy to learn and to immediately implement . Benefits can range from taking a history more easily, to understanding why we may struggle with certain patients more than others; from figuring out why previous management plans were not followed, to helping patients actively engage in their treatment. 

Presenter Bio
Nigel is a well-respected and engaging presenter as well as an experienced GP. He has a family practice in Queenstown and has taught medical undergraduate and postgraduates in the UK, USA and Australia as well as NZ. He is currently a teacher with the Rural Medical Immersion Programme for final year medical students at Otago University. He is also an active member of the Asia-Pacific educational faculty for a major medical indemnity provider.

Finally evidence-based studies of �wellbeing� � rather than �diseased being.�

We all know there�s more to life than being physically healthy but find little decent evidence of what really works from the �feel good�/self-help literature. Here�s an introductory seminar sharing what the latest scientific research says you can do to improve your own wellbeing � today (as well as that of your patients).

The last fifteen years have seen an explosion of academic research in the study of happiness and wellbeing , often referred to as positive psychology, with practical implications for our daily lives. As citizens of the 21st century we often lead busy stressful lives � even more so as doctors/healthcare providers. Because we�re apparently so time poor we want to learn what will be most effective for us in leading happier more fulfilling lives.

What two activities probably add �more life to your years� than any other?
Why should it matter to your patients � as well as yourself - exactly what emotional state you�re in when consulting? How can a simple, yet crucial, change in emphasis make all the difference in improving how your practice team works together? And why do the little things really matter?

Dr Nigel Thompson is a GP with a specialist interest in counseling, behavioural change and health coaching. He is up to date with research from the new field of positive psychology and its exciting implications for all health care workers.

Start your conference off on the right foot with a humorous and practical introduction to the good life as a doctor/healthcare provider.

Vaccinations are a large part of every practice nurse�s daily job. I will use data from the national 0800 phone line and other calls to our IMAC advisory service to identify common queries and themes from health providers and parents. This workshop will focus on the national schedule vaccines, challenges and concerns, and the private market vaccines: meningococcal vaccines, rotavirus, varicella, zoster, HPV for boys, adult pertussis and pneumococcal � what should we be considering and who should we be offering them to. It is an exciting time for vaccines, but also challenging for us all to keep up to date.

The world of vaccinology has moved considerably in the past few years. No longer can we assume the only thing we need to know is the basics of the national immunisation schedule and rely on the practice nurse to address the more challenging issues. There are now excellent vaccines on the private market that we need to be aware of and know when to offer them. Who would benefit from rotavirus, varicella, a range of meningococcal vaccines, pertussis and pneumococcal in adults, HPV for men, zoster vaccine�..and most of them do not come cheap! There are real dilemmas for our patients in balancing the costs against the gains, and yet ethically we cannot just assume cost is a reason not to offer these vaccines. This workshop will present an overview of the latest and greatest in vaccines, an up to date guide in what and how to offer vaccines to our patients. 

Toddlers make a transition from a dependent milk-fed infancy to independent feeding and a family based diet. The transition is accompanied by improved motor skills, increased energy and nutrient requirements, awareness of meal time behaviour, and appreciation for tastes and food preferences.

For the parents of toddlers the transition from infancy to toddler brings with it a number of challenges which are associated with normal developmental milestones these include: increased mobility; dawning self-awareness, and the onset of language. Caregivers for children at this age are responsible for providing appropriate foods in a proper setting, structuring mealtimes, and responding to food related behaviour. As toddlers gain responsibility for their food choices, many parents become concerned about meal refusal, erratic appetites, preference for sweet foods and salty foods, and undisciplined mealtime behaviour.


Using case studies this workshop will cover:
Toddler�s Nutrient Needs � growth and development
Toddler nutrition Issues
Healthy Habits for Healthy Children 
Dietary Suggestions/ Portion Sizes 
Handling Picky Eaters

We�ve all heard about the four vital signs, TPR and BP. But what about the fifth vital sign- Pain. In a short easy to remember talk, using an easy mnemonic, you can take an accurate pain history, remember the red flags, and have a brief overview of some investigations. It�s quick and easy and you�ll use it again and again triaging patients in a practice nursing, afterhours or A&E setting.

This is an interactive, user friendly overview. How do we approach musculoskeletal problems? What are the principles of neck pain? We will discuss posture, breathing, palpation, neuromuscular therapy, trigger points after a brief hands on review of surface anatomy, along with other important topics that will underscore your approach to musculoskeletal pain. We trust you will take home key strategies to help you manage this aspect of musculoskeletal medicine in your practice throughout the coming year. If you are able to attend further sessions, you will notice the flow of information and principles throughout the sessions, although each session will offer you �packaged� information and techniques.

This is an interactive, user friendly approach to the management of shoulder and upper limb pain. It follows from neck session. We plan to review hands on, important anatomy, history and examination points. Some key management� hands on techniques� will be demonstrated and practised, sot that will aid you in understanding the musculoskeletal problems pertaining to these areas. We trust you will take home key strategies to help you manage this aspect of musculoskeletal medicine in your practice throughout the coming year.

24 Hour Ambulatory BP monitoring is emerging as one of the most useful and simply high tech toold in the area of hypertension management. Devices are become simple to use, highly reliable and relatively inexpensive. A growing body of evidence demonstrated that elevated BP readings in the Doctor�s office are not the best way to define the hypertensive group and furthermore does not always define the at risk group.

24-hour monitoring is therefore useful in finding those who have white-coat hypertension and enabling decisions in those who have borderline hypertension or inadequate control. Long term risk in hypertension has not been shown conclusively to be related to the random readings in the doctor�s rooms. Risk is better defined by those who have evidence of left ventricular hypertrophy (on an ECHO) or evidence of other end-organ damage. To this list can now be added 24 hour ambulatory BP monitoring. The presence of persistently elevated BP over the period, particularly those who show no nocturnal dipping, defines a group with a worse prognosis. This type of monitoring can also be used to diagnose unexplained syncope (documenting hypotension) and sometimes suggesting unexpected diagnoses such as obstructive sleep apnoea, when marked nocturnal hypertension is present.

Utility, devices, thresholds and new management ideas in hypertension will be discussed.

Use of text-messaging in General Practice � New Recall Contact List feature for Medtech32.

If you have been thinking about using mobile text-message communications with your patients then this is the workshop for you. Come in and find out how 

� The doctors and nurses can make their life to communicate test results
� Improve your recall process, save nurse time on less administration and more clinical work
� Utilise the new recall function to make recalling very easy and effective
� Learn about how you can streamline Smoking A and B under Txt2remind and do both of these functions seamlessly
� Improve patient response 
� Patient privacy and safety

Use of text-messaging in General Practice � New Recall Contact List feature for Medtech32.

If you have been thinking about using mobile text-message communications with your patients then this is the workshop for you. Come in and find out how: 

� Doctors and nurses can make their life easier to communicate test results
� Improve your recall process, save nurse time on less administration and more clinical work
� Utilise the new recall function to make recalling very easy and effective
� Learn about how you can streamline Smoking A and B under Txt2remind and do both of these functions seamlessly
� Improve patient response 
� Patient privacy and safety

This session will focus on undertaking proactive HR management towards gaining the best possible outcomes from your processes and actions: robust decision making and role modelling that can make a difference.

Seeing the benefits of your hard work at building a resilient, professional staff team who enjoy coming to work and are proud to be associated with the practice can be the icing on the cake for managers. This doesn�t happen by accident � it�s an achievement that requires dedicated and ongoing work � but it�s possible if you have the right skills. 

Come along to this session if you are prepared to step outside your comfort zone and learn new skills to deal with all those potential conflict areas that we often shy away from. And I promise there will no embarrassing roleplaying (unless you instigate it yourselves).

This session will include four workshops to give you some tips on:
� What to look for when undertaking a pre-employment check
� Giving timely feedback towards nurturing the ideal culture for your practice 
� Drawing up a performance improvement plan
� Holding a disciplinary meeting.

Russell will discuss the state of the child protection system in 2013, with a focus on the Children's Action Plan that came out of Minister Paula Bennett's Green and White Papers on Vulnerable children. Important changes that will affect child protection in primary and secondary care include new rules for information sharing, children's teams, regional children's directors and the Vulnerable kids Information System.

Pulmonary embolism is a relatively common event with early mortality rate up to 15%. The diagnosis may be difficult to establish however. Confirming the diagnosis and early introduction of treatment is therefore important. The assessment of clinical probability will be highlighted. Application of Wells� criteria and the revised Geneva scoring system provide measures of risk of pulmonary embolism. Discussion will also focus on tests that can be undertaken in the community to determine the risk of recurrence of PE, and to monitor for the development chronic thromboembolic pulmonary hypertension.