This clinical bulletin provides up to date information on cervical cytology. It covers background information of cervical cancer including cervical cancer statistics, an overview of the New Zealand Cancer Audit 2004, and best practice advice on specimen collection for both conventional and liquid based smears.
The bulletin summaries the updated Bethesda Reporting System (2001) that was adopted by all New Zealand Laboratories in July 2005. Also included are the NCSP recommendations for follow up and an overview of the NCSP Operational Policy and Quality Standards for Smeartakers and Laboratory and Histology Service.
With over 2,000 new melanoma, and 70,000 new non-melanoma cases reported in New Zealand each year the diagnosis and management of skin cancers is an important part of general practice.
Although most skin cancers are easily treated, about 200 people a year in New Zealand die from melanoma, and approximately 60 people a year die from non-melanoma cutaneous malignancies, mainly squamous cell carcinoma. Although basal cell carcinoma does not have the same metastatic potential as squamous cell carcinoma, it can also cause significant morbidity – especially in those cancers occurring around the head and neck.
This Bulletin summarises information on melanoma and the current recommendations for excision of these lesions. Rarer tumours such as Merkel cell carcinoma, skin appendage carcinomas, cutaneous sarcomas and lymphomas will not be discussed.
Travel Advice Bulletin Download PDF
Many travellers believe a few injections a couple of days before departure will ensure them a healthy trouble free trip. This is far from the truth with traveller’s diarrhoea and respiratory tract infections being the major causes of morbidity and cardiovascular disease and injury the major causes of death in travellers. Simple commonsense advice such as the need for insurance is probably more important than vaccines for uncommon diseases. Such advice is outlined in this bulletin.
Travel medicine cannot be reduced to a chart. Recommendations need to be individualized and depend on the traveller, their itinerary and activities. Those who travel to visit friends and relations have documented higher rates of numerous diseases such as malaria, typhoid, tuberculosis and influenza. If you have such patients in your practice who may return home to a developing or tropical country suggest that they see you before such a trip. They will often not think to seek pre-travel advice as they lived there before without vaccinations or tablets. They need to understand that their risk of illness from infections such as malaria will have increased during their absence.
Travel Information Sheets Download PDF
Note: This PDF is 1.5Mb.
To assist you in providing general travel advice we have included a series of Traveller Information Sheets.
These cover:
- General travel advice
- Travelling with children
- Malaria
- Travel at altitude
- Travel related DVT
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FNA Bulletin Download PDF
Note: This PDF is 5.2Mb.
Fine-Needle Aspiration biopsy (FNA, FNAB) is a procedure involving the sampling of mass lesions for cytological examination and diagnosis. These lesions may be superficial or deep. Deep lesions such as lung, mediastinal and intra-abdominal tumours require radiological localisation techniques such as ultrasound and CT to accurately direct the needle to the lesions; these fine needle aspiration procedures are performed in radiology rooms with the appropriate equipment.
This bulletin refers solely to the aspiration biopsy of superficial lesions that can be palpated, localised and immobilised by hand, and are therefore able to be performed in the outpatient setting.
Management of Occupational Exposure to Blood or Body Fluid Download PDF
The blood borne viruses that pose a risk in the health care setting are Human Immunodeficiency virus (HIV), Hepatitis B virus (HBV) and Hepatitis C virus (HCV).
Exposures occur through needlesticks or cuts from other sharp contaminated instruments or through contact of the eye, nose, mouth or open skin with blood or body fluids.
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Disinfection and Sterilization of Reuseable Medical Devices in General Practice Download PDF
Transmission of infection through reused medical devices is well documented. This bulletin provides general information about cleaning, disinfection and sterilization to assist those responsible for these functions in General Practice.
For the disinfection and sterilization of reusable devices to be effective, meticulous attention to detail is essential. Staff must be properly trained and equipped to perform these duties in a safe and responsible manner.
There is now a joint Australian/New Zealand Standard document (AS/NZS 4815:2001) that provides detailed information on the requirements for disinfection and sterilization of reusable items in office based practice. The AS/NZ Standard also details the requirements for sterilizing wrapped instruments.
Some portable steam sterilizers (bench top sterilizers) have a drying phase that is not associated with a vacuum. Without a vacuum, the drying inside the wrapping may be incomplete. The AS/NZ Standard stipulates that a drying phase is necessary for items that are to be stored as sterile packs. The contents of packs must be dry immediately on completion of the cycle. There is no accepted method for measuring the complete removal of steam remaining on the enclosed items, so the claim that a drying cycle without a vacuum is sufficient for 100% drying cannot be substantiated. If steam remains inside the package, then the process is compromised.
The British standard (BS 3970: Part 4: 1990) for transportable steam sterilizers states: “The absence of a forced air removal stage and a post sterilization vacuum drying stage precludes the use of such machines for wrapped instruments or porous goods.” Porous goods include dressings.
Flexible endoscopes and heat sensitive equipment require special methods for sterilization. Readers should refer to the NZ Standards Guideline for Microbiological Surveillance of Flexible Hollow Endoscopes and the Australian Standards document AS 4187.
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Approaches to the Management of Common Infections in General Practice Download PDF
This bulletin assumes a basic knowledge and hands on general practitioner experience of managing infections in the community. It s predominantly about antibiotic selection and use but it is not a mini text book. It does not go into infinite detail. It does not tell you "what to do". It is unequivocally slanted in the direction of conservative antimicrobial use, i.e. endeavoring to minimise antibiotic use to when it's genuinely needed.
D-News March 2010 Download PDF
The first issue of D-News for 2010 features clinical articles and information on High Risk HPV, PSA testing, eGFR (estimated Glomerular Filtration Rate), fasting glucoses and rate of abnormal GTTs. Also included is an updated Key Contacts list, information on new access points and information on paying for tests.
Also now available is the Antibiotic Susceptibility Chart 2009.
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D-News August 2009 Download PDF
In this issue of DNews, Paul Ockelfords editorial focuses on the coming transition of Auckland community laboratory services. Clinical articles are Polycythemia, Recent Developments in Testing - Diabetes and Troponin, Cervical Cytology - Change to 100% ThinPrep LBC Testing. In Lab News, the New Lung Cancer Susceptibility Test - RespirageneTM is highlighted.
Also included is a notice regarding Swine-Origin Influenza Virus (S-OIV) Contact Numbers.
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D-News March 2009 Download PDF
In the first issue of DNews for 2009 Paul Ockelford’s editorial focuses on the Supreme Court Judgment. Clinical articles are Screening for Colorectal Cancer and Its Precursors, Dr Mee Ling Yeong, Dengue Fever, Dr Joan Ingram, and Neutropenia Drs Nicola Eaddy and Anna Ruskova. The Collection Centre Update includes new opening hours as well as a Collection Centre relocation.
Also now available is the Antibiotic Susceptibility Chart 2008.
Antibiotic Susceptibility Chart Download PDF
Susceptibility Testing for 2009 - this information is based on a large number of local isolates and is the best guide to Auckland community pathogen resistance rates.
For further advice please contact our Clinical Microbiologist on site, Dr Arthur Morris: – Phone 571 4000.
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Specialised Procedures Download PDF
Information about specialised tests and locations performing the testing or procedure. Please note that specialised tests and procedures require an appointment.
Specimen Labeling, Storage and Transport Download PDF
Guidelines for specimen labeling, storage and transport.
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