Yeah cool and my name is Joe Scott-Jones, I'm the clinical lead for Pinnacle and I'm currently working in the beautiful Waihi Beach, beautiful weather today and really looking forward to clinical snippets so the opportunity to sort of pick Dave's brains and find out what's the latest updates we need to take note of for primary care so Let's kick into it.

I'll do my best.

Yeah.

And I have worked, I have done locums at Waihi Beach previously, and I can absolutely agree with you that it's a beautiful place.

Not so much to be stuck in an office, I guess, but yeah, lovely little part of the world.

But anyway, let's get on with migraines.

And I brought this up both because BPAC's recently released a really good comprehensive update on migraine management, but also A not infrequent complaint I see in my complaints work is delayed diagnosis of subarachnoid hemorrhage.

Bound to be, I should say.

if you if you write the script then you're you're you're ensuring the monitoring is happening yeah

ultimately that's yeah it becomes your responsibilities so yeah So that's good old methotrexate.

Wonderful drug.

Yes.

Then on to vaccination.

This is just an update on HPV vaccination deliveries.

So Health New Zealand Te Whata Ora has announced an important change to how HPV vaccination is being delivered through the school-based information programme.

Zealand.

Thank you.

Number six ties in a little bit with what we talked about last week about deprescribing.

This one's specifically around deprescribing PPIs.

This comes from a recent research review educational series, which looked really in quite a lot of detail, the rationale for and the process involved in stepping down and stopping proton pump inhibitors.

So that's an article that's well worth reading because of the fact that PPIs are one of the most commonly prescribed medications and certainly are not totally benign.

But the review outlines best practices for PPI stewardship, including when and how to deprescribe and highlights a couple of deprescribing strategies, explaining how the alginate and tacit combination can reduce breakthrough symptoms during either the weaning or immediate cessation deprescribing process.

So there were a few practice points, which I'll just go through briefly here.

Thank you.