A practical workshop to cover diagnosis, marking out on pig skin, punch biopsy, anatomy of needles, suture choice, excision technique, borders, and simple ellipse repair, dog ear repair, principles of wound healing, and sterile wound care. Instruments and gloves will be provided. 

A practical workshop to demonstrate and practice on pig skin some flap repairs suitable for skin cancer work as rotation and advancement flaps. Other flaps as Wolfe grafting, split skin grafts, Lazy S, VY repair,and Z plasty will be presented. Discussion on choice of technique, relaxed skin tension lines, and complications. Instruments and gloves will be provided. This workshop is more suitable for GPs with prior surgical experience, and attendance to one of the prior Basic Workshops is recommended. 

New Zealand has the highest vasectomy rate in the developed world, with 57% of men aged 40-49 firing blanks.

John provided a primary care based vasectomy service in the UK for 20 years, logging over 5000 procedures. Initially using a cut & tie technique, John switched to the no-scalpel method in 1998. 

The workshop will cover how to get started with training & supervised practice, equipment requirements, patient selection, information provision and consent forms, operative procedure video, local anaesthesia methods, vasa occlusion methods, sedation, complications, semen analysis, failure rates, post vasectomy pain and audit, plus useful web resources. During this time, I will try to slay some of the mythology that still abounds!

If there is time, we can discuss contract negotiation with health purchasers. 

Participants are welcome to take away electronic copies of the patient information leaflets and consent form to adapt for their own use. Please bring a USB stick.

Also known as Intramuscular Stimulation, this will be a practical, hands on workshop, so come prepared to be demonstrated on! Participants with musculo-skeletal pain are welcome.

I will give a brief overview of how it seems to work based on the concept of muscle shortening (no science involved), review some cases, show some typical pain referral diagrams and then demonstrate trigger point identification and treatment by examination & needling. The main skill is examination technique to find the painful bits and the only essential knowledge is knowing where NOT to needle!

I use this technique during normal GP consultations: it is rapid and effective in about 70% of cases. Typical problems treated include neck, shoulder and back pain (including those with radiculopathy), chronic headaches and migraine, trochanteric bursitis and epicondylitis.

GPs who have introduced needling techniques into their usual practice, generally report a reduction in referral rates and decreased prescribing of analgesia and anti-inflammatories, not to mention some increased work satisfaction! Some patients even return to work after years on the benefit system!

If time allows, we can include acupuncture treatments that have been shown to be effective for the nasal symptoms of hay-fever and OA of the knee.

This session will explore the depth & breadth of wilderness medicine as an emerging discipline, illustrated with cases from around the globe. So, whether you are going as the medic on a charity bike ride, pushing the survival limits at altitude or near the poles, volunteering for disaster relief work or going into a war zone, come along for a light-hearted sharing of experiences, where necessity really is the mother of invention!

We will look at the vital importance of the 7 Ps (proper planning & preparation prevents p*** poor performance), information sources, suitable training, the common problem of pre-departure concealed illness, realistic medical kits, evacuation options and working with local health care providers.

I will bring along some of my treasured items of equipment that I would not leave home without.

Dr Grant Beban
Upper GI and Bariatric Surgeon
ADHB and Auckland Weight Loss Surgery
Website: www.awls.co.nz 
Email: gbeban@awls.co.nz 
Phone: 021 938 385

Dr Richard Babor
Upper GI and Bariatric Surgeon
CMDHB and Auckland Weight Loss Surgery
Website: www.awls.co.nz 
Email: rbabor@awls.co.nz 

Bariatric surgery (surgery for weight loss) is increasingly being used in New Zealand and internationally for the treatment of severe obesity and its associated illnesses.

Although the evidence of the efficacy and safety of bariatric surgery is well proven, many practitioners would like to know more about the different types of weight loss surgery, the pros and cons of these operations, who might be appropriate for weight loss surgery, as well as follow-up and troubleshooting. These issues will be discussed through a series of case presentations. Participants are encouraged to bring their own cases and questions for discussion.

Chronic insomnia, defined as difficulty initiating or maintaining sleep that impacts on daytime functioning, affects between 10% and 15% of the adult population. It creates a significant burden on the health system and industry due to the fatigue that ensues, and resultant risk of accidents, mental and physical illness, and absenteeism.

The 24hr society is here to stay, and approximately 20% of the workforce in western countries is required to work outside the hours of 8am to 5pm. However activities that require a change in a normal sleep pattern are of most concern. These might include work schedules, or social and environmental pressures impacting on the ability to sleep at the ‘normal’ biological time. 

Circadian disorders may be either self inflicted as with Shiftwork or Jet Lag, or biological as with Delayed Sleep Phase Syndrome commonly seen in adolescents, or Advanced Sleep Phase Syndrome seen in the elderly. Genetics can also determine morning and evening ‘chronotypes’. 

GP’s are in an ideal position to recognise and treat these conditions that affect a growing number of their patients. Identifying these problems and understanding how to treat or manage them will be covered in this workshop. 

Dr Mary Birdsall
Reproductive Medicine, Medical Director
Fertility Associates 
www.fertilityassociates.co.nz  
info@fertilityassociates.co.nz 
Phone: 0800 10 28 28

This workshop will overview how to perform a cervical smear and how to perform pipelle endometrial sampling.

My top tips for performing a good cervical smear are:
1. Never do a smear when a woman is menstruating
2. Postmenopausal women often benefit from 1 month of vaginal oestrogen prior to a smear
3. Vaginas slope backwards
4. If you are having difficulties locating a cervix then remove your speculum and perform a bimanual exam in order to find the cervix

Pipelle sampling is an easy office based investigation and the indications are irregular vaginal bleeding in over 40’s, post menopausal bleeding or bleeding on tamoxifen. It is important to exclude pregnancy and infection prior to performing a pipelle. Please tell women that a pipelle will be uncomfortable for a brief moment and that a result is not always obtained. An insufficient sample is an indication for referral as 20% have some pathology.

There is more and more evidence that fertility of both men and women may be improved by lifestyle changes.

For a man, the important factors are to stop smoking, avoid marijuana, reduce alcohol to 20 units per week and have a normal BMI. Keeping testes cool is also important and there is emerging data around the benefits of a diet rich in antioxidants. Menevit which is a male supplement has been shown to improve pregnancy rates in men with poor sperm whose partners are having IVF treatment. There is a possibility that SSRI’s may also have a negative influence on male fertility.

For women, the evidence suggests that cigarettes have a big influence on fertility and age at menopause. Weight also plays a role with a BMI less than 20 or greater than 25 reducing the chances of conceiving and increasing miscarriage risk. Caffeine and alcohol intake are also liked to lowered fertility but the major factor in female fertility is age – so whenever a patient asks you when she should start trying to conceive, the answer should always be…now is good!

Irregular vaginal bleeding is a common presentation and there are traps for the unwary. Here are my top tips to diagnose and manage irregular bleeding:

1. Always exclude pregnancy
2. Examination is mandatory including abdominal palpation and a speculum examination
3. Perform a cervical smear even when not due
4. Remember infection as a cause of bleeding
5. Bloods: FBC, ferritin, FSH, LH, hCG, sometimes prolactin, testosterone
6. Pipelle endometrial sampling is an easy office based procedure
7. Pelvic ultrasound often useful
8. Progesterone will stop almost all hormonal bleeding

Graduated at Otago Medical school in 1976.Trained in Paediatrics/Neonatology at Christchurch, London(UK),Melbourne and San Francisco. Appointed as Paediatrician at Waikato Hospital in 1985.Employed as fulltime Neonatologist since 1989.Additional subspecialty interest in Paediatric Endocrinology. Married with 2 adult children.

Dr David Bourchier
Neonatal Paediatrician
Waikato Hospital
David.Bourchier@waikatodhb.health.nz 

Issues relating to the preterm infant which present to a Practise Nurse will be discussed. A brief review of outcomes will be presented followed by extended discussion on immunisations, Vit K, feeding issues ,jaundice and the newborn screening card

The presentation will focus on recent changes in Neonatal medicine which are likely to impact upon General Practitioner careThe expanded newborn metabolic screening and newborn hearing screening programmes will be reviewed.Antenatal risk factors for preterm delivery,fetal antenatal renal pelvis dilatation,Kernicterus and Vit D will be included.

A brief overview of changes in Neonatal practise over the past 50yrs will be presented.Long term followup data will be presented.This will include growth,school performance,personality and employment issues

 
Joi is Fertility Associates’ Counsellor Team Leader of the Auckland clinic. She initially trained as a teacher and then became a social worker at National Women's Hospital in the 1980s where she provided a counselling service for people experiencing infertility. She joined Fertility Associates in 1987 as a founding staff member. She is a founding member and current chairperson of the Australian and New Zealand Infertility Counsellors’ Association and a member of the Fertility Society of Australia’s Reproductive Technology Accreditation Committee. Joi is also a founding member of Fertility New Zealand, and a registered member of the Aotearoa New Zealand Association of Social Workers.

Mrs Joi Ellis
Specialist Fertility Counsellor
Fertility Associates 
www.fertilityassociates.co.nz  
info@fertilityassociates.co.nz 
Phone: 0800 10 28 28

The IVF experience can have an enormous emotional impact on your patients. 

Specialist fertility nurses have a key role coordinating care during fertility treatment. They work closely with specialist fertility counsellors to assist patients holistically.

There are a wide range of fertility treatments and laws governing assisted reproductive technology that impact the support a patient will need.

There are many resources available to assist GP’s in the support of their patients’ journey to a baby on the fertility treatment pathway.

Armed with better understanding, GPs can help their patients survive their fertility problems and ensure they get the best service from the fertility clinic.

Dr David Bratt, Principal Health Advisor to the Ministry of Social Development

After graduating from the Otago University New Zealand in 1973, Dr Bright worked at the Plastic Surgery Unit of the Burwood Hospital Christchurch before moving to Australia in June 1974. Dr Bright then worked as an intern, resident and registrar on medical and surgical teams until the end of 1978. In 1979 he joined general practice. 

In 1994 Dr Bright interest in cosmetic medicine evolved with chemical peeling and laser surgery. When the Cosmetic Physicians Society of Australia started examinations and credentialling for lasers, Dr Bright was one of the first to pass these examinations and be accredited. 

Dr Bright derives a great deal of personal satisfaction from his work. Patients, young and old, male and female are making changes through cosmetic surgery which improves their confidence, presentation and self esteem. It is rewarding to be a part of that change".

Dr Bright regularly attends workshops and conferences in Cosmetic Medicine, Liposuction, Laser Medicine and Phlebology to keep abreast of the latest developments and techniques in cosmetic medicine. 

Dr Ralph Bright
Cosmetic Physician
Macquarie Cosmetic Medicine
www.macquariestemcells.com 
www.cosmeticmedicine.com.au  
doctor@cosmeticmedicine.com.au 
Phone: 61 2 9824 3044

Chronic inflammation is well recognized in all the major degenerative illnesses. Fat becomes more inflamed as BMI rises but not for everyone. It is important for us to know when our fat is inflamed and how to correct that inflammation so as to prevent the major degenerative diseases such as diabetes, osteoporosis, sarcopaenia, ischaemic heart disease, stroke and alzheimers. In the catabolism of aging an inflammatory signal could trigger loss of muscle cells even in the absence of overt inflammatory disease.

The markers of inflammation we have available to us are not very sensitive. They include CRP, ESR and insulin resistance.

Certain subtypes of adenoviruses infection lead to long-term hyperplasia and hyperproliferation of adipocytes, associating these adenoviral infections with a high propensity for subsequent obesity.
Causes of inflammation include genetic predisposition, socio-economic status, diet (antioxidants, saturated fats and calorie restriction), exercise, obesity and stress.

Protective factors include genetics, diet (calorie restriction, antioxidants, resveratrol and anti-inflamatories).

Obesity causes obesity. This is exemplified by the hypothalamic adrenal axis syndrome. Patients need help to break these cycles.

Fat in the right place is beautiful. Fat in the wrong place is ugly. 

Keeping your fat in the right place and healthy is a sign of virility, fertility and strength. 
Flabby fat is associated with disease, age, senility and poor performance.

Fat becomes more inflamed as BMI increases but not for everyone. We all know someone who is big, very active, strong and has a normal BP and blood sugar. Their fat is not inflamed. They are able to protect their fat. 

The strong proinflammatory potential of adipose tissue suggests an important role in the systemic innate immune response. Leptin is released from fat into the circulation in response to infection where it modulates the proliferation and activation of peripheral T lymphocytes. Levels correlate with total body fat mass. 

If you don’t have enough fat you look sick. 

Fat is richer in stem cells than bone marrow and easier to harvest. That fat on your belly is a very valuable stem cell bank that is available to treat future illness.

Embryonic stem cells divide to form every cell in the body. Once the fetus has all the cell types adult stem cells predominate (even though the baby has not been born). The primary role of adult stem cells is repair then regeneration. If a cell is beyond repair it is replaced.
Stem cells don’t always receive the signals they need. We can change the signal or move the cells to a location where they are exposed to the signals we want. 
Exercise stimulates stem cells. Wnt7 is a protein that can be injected into muscle to increase the number of muscle stem cells and thence muscle bulk. PRP contains numerous cytokines including TGF-alpha which is known to attract stem cells. 

I have been collecting stem cells from fat (autologous) and injecting them into Osteoarthritic joints. There have been no adverse events and all patients have received some benefit. Whilst in the fat the stem cells did not protect the joints but once transferred to a joint full of inflammatory cytokines they respond with all the power that stem cells are famous for.

Dr Peter Chapman-Smith
Skin and Vein Clinic
chappie@clear.net.nz 
Phone 0800 1 4 VEINS

A practical workshop to cover diagnosis, marking out on pig skin, punch biopsy, anatomy of needles, suture choice, excision technique, borders, and simple ellipse repair, dog ear repair, principles of wound healing, and sterile wound care. Instruments and gloves will be provided. 

A practical workshop to demonstrate and practice on pig skin some flap repairs suitable for skin cancer work as rotation and advancement flaps. Other flaps as Wolfe grafting, split skin grafts, Lazy S, VY repair,and Z plasty will be presented. Discussion on choice of technique, relaxed skin tension lines, and complications. Instruments and gloves will be provided. This workshop is more suitable for GPs with prior surgical experience, and attendance to one of the prior Basic Workshops is recommended. 

Leg ulcers are 80% venous in origin and consume 1-2% of Vote Health each year. Effective healing involves treating the underlying chronic venous insufficiency and venous hypertension, use of adequate class 2 compression and good nursing. Secondary infection and necrotic debris needs attention. The vast array of available ( expensive) dressings make little difference to healing times. 
Compression aids healing, reduces interstitial oedema and needs to be worn 24 hours daily until healing occurs. Frail elderly patients can use various devices to assist the wearing of compression hose which need to be a minimum of class 2 strength ( 35-40mm Hg at the ankle). Peripheral vascular disease can complicate this.

Non surgical treatment of varicose veins is the first line option in most western countries, not yet available in the NZ public health system. Endovenous laser ablation (EVLA) has become the most effective, safe option with high patient acceptance, and is funded by private medical insurance. Foam ultrasound guided sclerotherapy (UGS) is used concurrently to occlude distal trunks and tributaries. Careful post treatment surveillance with duplex ultrasound is necessary to exclude thrombotic sequelae, and to document efficacy of treatment. 

Post thrombotic syndrome (PTS) following deep venous thrombosis (DVT) has been recognised for some time but is poorly understood. This is a debilitating condition with life long discomfort, leg swelling and oedema. More common with proximal DVT but seen also after mere calf DVT, it is reduced by 50% by simply wearing class 2 compression hose for 24 months post DVT, rarely prescribed by GPs. TED stockings continue to be widely prescribed consuming health funds– completely useless in the ambulant patient. 

Leg ulcers are 80% venous in origin and consume 1-2% of Vote Health each year. Effective healing involves treating the underlying chronic venous insufficiency and venous hypertension, use of adequate class 2 compression and good nursing. Secondary infection and necrotic debris needs attention. The vast array of available ( expensive) dressings make little difference to healing times. 
Compression aids healing, reduces interstitial oedema and needs to be worn 24 hours daily until healing occurs. Frail elderly patients can use various devices to assist the wearing of compression hose which need to be a minimum of class 2 strength ( 35-40mm Hg at the ankle). Peripheral vascular disease can complicate this.

Non surgical treatment of varicose veins is the first line option in most western countries, not yet available in the NZ public health system. Endovenous laser ablation (EVLA) has become the most effective, safe option with high patient acceptance, and is funded by private medical insurance. Foam ultrasound guided sclerotherapy (UGS) is used concurrently to occlude distal trunks and tributaries. Careful post treatment surveillance with duplex ultrasound is necessary to exclude thrombotic sequelae, and to document efficacy of treatment. 

Post thrombotic syndrome (PTS) following deep venous thrombosis (DVT) has been recognised for some time but is poorly understood. This is a debilitating condition with life long discomfort, leg swelling and oedema. More common with proximal DVT but seen also after mere calf DVT, it is reduced by 50% by simply wearing class 2 compression hose for 24 months post DVT, rarely prescribed by GPs. TED stockings continue to be widely prescribed consuming health funds– completely useless in the ambulant patient. 

Ted Maiman built the first (ruby) laser in 1960, and almost immediately medical applications of this magic light were proposed. The unique properties of single wavelength over a wide range from ultraviolet to far infrared, collimation and intensity, combined with the light absorbing properties of the various human tissues, have led to a plethora of lasers and applications. Many of these have had a short life, but others are now a fixture, with new applications being developed continually.

Ophthalmology, urology, cosmetic medicine and oncology amongst other specialties all routinely use lasers for applications from the simple such as pain relief, to the technically demanding such as corneal sculpting and cancer therapy. Lasers can be used from the GP practice setting, right though to the operating room. However lasers do have significant potential safety issues for both staff and patient, and must be used carefully. It is hard to imagine modern medical practice without access to lasers. The overwhelming majority of laser procedures are highly successful, and staff incidents are extremely rare. This brief talk will give an overview of the place of lasers in medicine today.

Ever since early mankind realised that excessive sunlight caused unpleasant side effects, we have been experiencing natural photochemical effects. While even the ancient Egyptians prescribed sunlight exposure for certain conditions, it was only in the 19th century that light was scientifically used in medicine. About 50 years ago it was realised that certain chemical compounds could react to light, and have significant effects on tissue. Photodynamic therapy (PDT) was the outcome. Possibly the first true PDT was the use of coal tar as a photosensitiser plus UV-A light in the treatment of psoriasis - the so-called PUVA therapy. 

PDT is essentially the introduction of a substance which reacts to light ( the photosensitiser) into or near target cells, followed by irradiation with light (usually a laser) of just that wavelength which raises the energy of the photosensitiser, causing it to form singlet oxygen molecules. These are highly reactive and will destroy the cells by necrosis or apoptosis. The targets have been up to recently mainly tumour cells, but now we are moving toward other targets such as fungi, acne and pre-cancerous lesions. While PDT has known side effects, and the photosensitisers are still far from ideal, PDT already has a very useful place in medicine.

Dr Richard Fisher
Reproductive Medicine
Co-founder, Fertility Associates 
www.fertilityassociates.co.nz  
info@fertilityassociates.co.nz 
Phone: 0800 10 28 28

Mark Fraundorfer is a urologist practicing in both the public and private sectors in Tauranga New Zealand. He, with long term colleague Peter Gilling, are best known for their pioneering work on the use of the Holmium laser in the treatment of obstructive benign prostatic hypertrophy and has published extensively on this subject. He also has sub specialty interests in Paediatric Urology, stone disease and in prostate brachytherapy. He was the architect for the novel delivery of publicly funded elective urological services based on a population basis and delivering maximum waiting times to be assessed and operated on within two and six months respectively, the “Venturo” model. 

This session will explore such issues as the timing of therapy introduction, which therapy, intermittent versus continuous, and the role of lifestyle changes, diet and alternative therapies. An update on future directions of treatment will be provided.

Erectile dysfunction, foreskin problems, prostate problems and the early detection of prostate cancer, treatment options for benign prostate disease and prostate cancer, testicular cancer diagnosis, scrotal lumps and bumps.

Ed Gane is Associate Professor of Medicine at the University of Auckland, New Zealand and Director of the New Zealand Liver Transplant Unit at Auckland City Hospital. He trained in Hepatology at the Institute of Liver Studies, King’s College, London. On his return to New Zealand in 1996, Associate Professor Gane was appointed Chief Transplant Physician for the first New Zealand Liver Transplant Programme. 

Associate Professor Gane has been the Government Clinical Advisor to the National Hepatitis B Screening Programme since 1998 and this year was appointed as Champion for HCV for the Ministry of Health. He is involved in several current phase I, II, III and IV clinical trials of new antiviral therapies for HBV and HCV before and after liver transplantation. 

Associate Professor Gane is extensively published, with over 100 first author papers, including in Lancet and New England Journal of Medicine.

Des is Head of the University of Auckland’s School of Medicine. He is strongly interested in the development and maintenance of an effective health workforce. He is the Executive Chairman of Health Workforce New Zealand and is a member of the National Health Board. 

Des is ethnically European and Māori. His iwi is Ngapuhi. He is committed to promoting indigenous peoples’ health. 

He has a doctorate in medicine (MD), which was conferred by the University of Auckland, and a doctorate in philosophy (PhD), which was conferred by the University of Sydney. Both doctorates were awarded on the basis of research into brain injuries. His other clinical interests are largely in the disciplines of toxicology and occupational medicine. 

Des served in the Royal Australian Navy and trained as a Submarine Officer in the United Kingdom and as a Clearance Diving Officer in Australia and North America. 

 
Janet Harp is the Senior Nurse Advisor and Relationship Manager for McKesson New Zealand the contracted provider of Healthline the national 0800 telephone triage and advice service. 

She is a registered nurse and has worked in a variety of clinical positions both in the UK and New Zealand. She spent 6 years in ED and completed a Post Grad certificate in Advanced Trauma Emergency Nursing prior to commencing employment at Healthline in 2000. 

Janet is responsible for providing clinical governance advice and support through nurse leadership and acting as a quality champion across the New Zealand business to ensure that clinical care is of the highest standard.

She is also responsible for the maintenance of effective relationships with key Healthline clients and stakeholders. 

Janet Harp
Senior Nurse Advisor Telephone Triage
McKesson NZ
www.moh.govt.nz/healthline 
janet.harp@mckesson.co.nz 
Phone: 04 4948176

Andrew Harrison graduated from Otago University in 1986 and undertook his rheumatology training in Wellington and at the Royal Postgraduate Medical School at Hammersmith Hospital, London UK, where completed a PhD in inflammation biology. He returned to Wellington in 1996 as a consultant rheumatologist and is currently Clinical Head of the Wellington Regional Rheumatology Unit, Hutt Hospital, and Senior Lecturer in Medicine at the University of Otago, Wellington.

He has a clinical interest in musculoskeletal ultrasound. His research interests range from the genetics and pathophysiology of gout, rheumatoid arthritis and ankylosing spondylitis to the social, cultural and organisational determinants of access to health care. He is currently President of the New Zealand Rheumatology Association and Medical Advisor to Arthritis New Zealand. 

Professor Shaun Holt is the founder of Clinicanz, New Zealand’s only clinical trials Site Management Organization. Previously, he was the founder of P3 Research, an independent clinical trials unit based in Wellington and Tauranga, and Research Review, a company that produces regular reviews of the medical literature for health professionals. He is Ex-Medical Director of Clinical Trials in the Wellington Asthma Research Group. Shaun holds Pharmacy and Medicine degrees, has been the Principal Investigator in over 50 clinical trials and has over 80 publications in the medical literature. He is Honorary Research Fellow at the Medical Research Institute of New Zealand, an Advisor to the Asthma and Respiratory Foundation, a regular contributor on TVOne's Breakfast programme and national radio shows and lectures at the Victoria University of Wellington. 

Professor Shaun Holt
Clinicanz, Medical Research Institute of NZ, Victoria University of Wellington
http://flavors.me/shaunholt 
holtshaun@gmail.com 
Phone: 029 200 11 11

Rod Jackson is a professor of Epidemiology at the School of Population Health, University of Auckland. He is medically trained, has a PhD in Epidemiology and is a member of the New Zealand College of Public Health Medicine. He teaches epidemiology to public health and healthcare students and practitioners. Rod and his colleagues developed a simple pictorial representation of all epidemiological studies - the GATE (Graphic Approach To Epidemiology) frame - that they use as the framework for teaching study design and study appraisal. Rod is the director of EPIQ, a collaboration of academics and health professions working in Effective Practice, Informatics and Quality Improvement (www.epiq.co.nz). His main research interest is the epidemiology of cardiovascular diseases. He is one of the architects of New Zealand risk-based clinical guidelines for managing CVD risk and leads a team that developed PREDICT, a web-based clinical decision support system that simultaneously gets evidence, about CVD risk and risk management, into and out of practice.

Professor Rod Jackson
Academic Epidemiologist
University of Auckland
rt.jackson@auckland.ac.nz 

Graduated from Calcutta Medical College in India in 1990
Diploma in Psychological Medicine from University of Ranchi, India in 1993
Membership of Royal College of Psychiatrists in 
Master of Philosophy from University of London
Diploma on Cognitive Behavioural Therapy from St George’s Hospital and Medical School, London
Fellow of Royal Australian and New Zealand College of Psychiatrists

Completed Psychiatric Training in London from St George’s Rotation and Maudsley Hospital and migrated to New Zealand in 1997. Served as Clinical Director of Mental Health Services in Rotorua till 2006. Additional positions held were Director of Clinical Training, Director of Postgraduate Education in Psychiatry, Intern Supervisor and Director of Area Mental Health Services. Moved to Waikato District Health Board as Forensic Consultant Psychiatrist in 2006. Attached to University of Auckland and Waikato Clinical School as an Honorary Clinical Associate Professor. Have more than 45 publications in peer reviewed journals and have written chapters in text books. 

Current area of research is burnout and job satisfaction in New Zealand Psychiatrists.

Graduated in medicine at Auckland University 1981.

Spent some years in general practice in Nelson.

Undertook his FRACP and dermatology qualifications in Auckland
Undertook postgraduate training in Mohs surgery, photomedicine and laser dermatology at St Thomas Hospital, London and NYU Medical School, New York.

Established in private dermatology practice with part time consultant attachment at Auckland Hospital in 1992.

Currently in full time private dermatology practice in Auckland, with special interests in dermatologic surgery, including Mohs surgery, dermatologic laser medicine and surgery, and cosmetic dermatology procedures.

Zak Moaveni took up a position in late 2009 as Plastic & Craniofacial surgeon at Middlemore and Starship Hospitals. He was previously the Clinical Director of Plastic Surgery at Waikato Hospital. His private practice in Hamilton focuses on both aesthetic and reconstructive plastic and hand surgery. 

Zak regularly attends national and international meetings both as participant and lecturer. He is also passionate about teaching and the delivery of reconstructive surgery (especially for cleft lip and palate deformities) in developing countries. He and his wife are excitedly expecting their third child later this year and he loves running and fly-fishing. 

Mr Zachary (Zak) Moaveni
Plastic Surgeon
Middlemore Hospital
info@zacharymoaveni.co.nz 
Phone :0210781345

This presentation will briefly review the epidemiology, genetics, and neurobiology of ADHD. Research regarding the persistence of ADHD into adulthood will be summarised. The presentation, assessment, and treatment of ADHD will be discussed, with particular emphasis on Adult ADHD and on the significant morbidity and co-morbidity of ADHD at all stages of development. More recently available medication options will be reviewed. 

• Work out what makes people tick.
• Speed read others to find out what they really want.
• See things as they see them. (in their shoes)
• Communicate in a way that makes people want to listen.
• Know what makes people love coming to work.

Gareth is a well-known media columnist and commentator and sought-after conference speaker. He has co-authored with his wife, Joanne, 3 books on their offshore motorcycle trips – Silkriders, Backblocks America and Under African Skies – and has written three books on personal investment, Pension Panic, KiwiSafer and After the Panic. His latest books are Poles Apart, an appraisal of the science of climate change, and Health Cheque, a review of New Zealand’s public health system.

Gareth graduated from Victoria University with a PhD in economics 1982.

Dr Gareth Morgan
Economist, Portfolio Investor, Author
www.healthcheque.co.nz 
gareth@garethmorgan.com 
Phone: 04 4946430

This presentation will summarise the findings of Gareth’s 2009 book Health Cheque and his emerging thoughts on a Prescription for Change in the New Zealand health system. Health Cheque found that New Zealand’s publicly funded health system is in good shape given what we can afford to spend on it, largely thanks to the hard work of the people within the system. However there are still enormous future challenges including rising expectations, the ageing population, new technology, poor productivity and the rise of chronic diseases. Meeting these challenges will require changes in how treatment is prioritized, a greater investment in reducing demand for care, and a rethink of how services are organized and configured. Currently treatment is prioritized on an ad hoc basis, and as a result is influenced by the media, politics and lobbying. An impartial system is needed with a focus on investing public money to get the greatest health return. New Zealand does relatively well on prevention and primary care, but many changes are needed to prevent and manage the future growth of chronic disease. Finally we must move away from small, provincial hospitals and fragmented administration so that a greater investment can be made in primary care.

A beginner's guide to skin surface microscopy, covering the basics of dermoscopic features and diagnosis of common pigmented skin lesions. 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. First step is to identify melanocytic lesions by their pigment network or globular pattern - if not, is this basal cell carcinoma, seborrhoeic keratosis, a vascular lesion or dermatofibroma? If it is melanocytic, its asymmetrical structure, atypical network or blue-whitish structures may indicate melanoma. 

The lecture will not cover all you need to know to prescribe isotretinoin - this takes years of experience. If keen to prescribe, choose well-motivated and mature patients that will do well with low-doses and can be relied on not to get pregnant. As GPs rarely manage many patients with severe acne, refer these, as they may need additional treatment and higher doses of isotretinoin thus experiencing troublesome mucocutaneous side effects. 

Vulval itch can be easily fixed or a lifelong battle. Recognise common causes: Candida albicans infection (confirm with high vaginal swab), irritant dermatitis (irritants such as washing, scratching, urine cause a burn-like rash on exposed sites), lichen simplex (young, lichenification of labia majora), psoriasis (more rash than itch), seborrhoeic dermatitis (subtle rash in hairy areas and creases), and lichen sclerosus (mostly >50 years, structure and colour change of mucosal aspect of vulva). Consider less common causes: lichen planus (various types), plasma cell vulvitis, and especially, vulval intraepithelial neoplasia (VIN). Manage with empathy and careful examination; treatment depends on diagnosis. 

Dr Mike O’Rourke
Ophthalmologist
Park Street Eye Clinic - Tauranga
Chairman NZ branch Royal Australian and New Zealand College of Ophthalmology 
Committee of RANZCO Strabismus Society
Trustee of Glaucoma NZ
Medical advisory board - Macula Degeneration NZ
Alcon board of advisors
Midor@xtra.co.nz 
Work - 07 571 1714
Home - 07 579 3083
Mob - 021 829 355
 

Glaucoma is not one disease, but many. A presentation will be given on glaucoma, briefly, outlining the wide range of different diseases and manifestations. Emphasis will be placed on a practical approach of a general practitioner to this common eye disease which is the second most common condition causing blindness in our society. Signs, symptoms, tests and what to do about them will be covered. The management of the disease, treatments, side effects and the surgery patients may have to suffer will be covered.

Because glaucoma is so common this presentation will be personally relevant to all in the audience as well as their patients.

The US are doing it, the UK are doing it, Australia, Scandinavia and Canada are doing it. Does that make it right?

Bowel cancer is the commonest cancer in NZ with 2400 cases diagnosed per year. In May 2008 the government announced that a national screening program was being investigated.

What is the evidence for sceening? What options are available and where are things at in New Zealand currently? Can we afford to do it or can we afford not to do it?

I will discuss stool testing, colonoscopy, CT colonography and colon capsule. I will discuss resource implications and the General practitioners role.

This will be a practical overview of what LFTs are, why we check them and what various abnormalities mean. I will also give rules of thumb on when a patient should be referred for specialist assessment.

20% of people have symptoms of dyspepsia. The use of PPIs has doubled since Losec came off patent globally. Studies in New Zealand suggest that vast numbers of patients are on long term PPIs despite not having clear evidence based indications. This session will discuss GORD, the exciting technological advances in diagnosis, options for treatment and how to stop treatment.

Not telling!!

When prescribing, GPs need to be aware of their patients profession and hobbies. GPs have at time to deal with patients who are pilots. Some drugs are either prohibited or require special Civil Aviation approval. In general terms when treating a pilot, fitness to fly determination depends both on the condition being treated and the treatment itself. In this workshop, Dr Claude Preitner, discuss particular considerations that Medical Practitioners should give when treating pilots, and conditions that are of particular concern to flight safety. He also addresses Medical Practitioners legal obligations in regard to those conditions and treatments of concern and advises on available resources. 

Passenger fitness to fly is an important topic that commonly crops up in General Practice consultations. As air travel becomes more accessible, the age of the travelling public goes up. This results in an increase in the number of passengers flying with medical conditions. The aircraft environment can exacerbate pre-existing medical problems leading to problems in-flight. Dr Sarah Aldington discusses how to assess fitness to fly and also discusses in-flight medical emergencies.

A selection of useful titbits for GPs from the world of Gastroenterology as viewed through the eyes of a Consultant Gastroenterologist. Starting at the top (mouth) and going right down to the bottom (literally), this session will help you feel confident in advising on all aspects of digestive health and disease.

The specific content of this session is down to you, the participants. So don’t have a jaundiced view on the world … come along armed with your questions, your cases, in fact anything to do with the liver. It could be everything you ever wanted to know about the liver but were afraid to ask!

He also writes for a number of magazines and is passionate about use of the media for educational purposes. 

He enjoys the outdoors with his family whenever he can and has had a new lease of life after relinquishing private obstetrics. 

Whilst lasers have been popular in Gynaecology with ablation of endometriosis, the current use is quite limited with the occasional use for the younger patient having a repeat cervical loop excision. Current innovative energies for us include microwave and the increasingly popular Radiofrequency Energy. The latter has enabled effective minimally invasive treatment for heavy periods as a day stay procedure, with 90% success at 5 years. His talk will focus on this and include data from his series which is the largest in New Zealand. 

Heavy periods are a major issue for around 20% of NZ women. They cause major physical, emotional and economic morbidity. If that wasn't enough the bewildering array of managements for them cause their own issues and each treatment has its own problems. Anil will try and present the investigation and treatment in a succinct and practical way to help you to help your patients to make the right choices. After the workshop you should be able to decide who to investigate and how. He will also present a brief update on the HPV vaccine. 

The Mirena IUS is one treatment that has revolutionised the management of heavy periods. Anil has distilled his many years of insertion of the device and will present practical tips for this. He will also demonstrate and go through Pipelle endometrial biopsies and the use of ring pessaries for prolapse. One aim will be tips for minimal discomfort to your patients. The session will start with a brief version of the Menstrual Disorders talk. 

The failure rate of native tissue prolapse surgery has been around 25-50% for some time. The surgical management of uterogenital prolapse and stress incontinence has undergone a radical change in recent years. The use of polypropylene mesh has significantly increased efficacy but created new issues for some patients as well. In this talk, Anil will present a concise account of where we are now and where we are going. The aim of the talk is to empower you with the knowledge to reduce your patients' anxiety. Mesh for all, some or none?

Old age is difficult to define and for the concerned health professional chronological age is only a very rough guide at best to client needs. The characteristic of older people which distinguishes them most from younger people is heterogeneity; old age produces much more variation in physical and mental capabilities than is apparent within cohorts of younger people. In purely chronological terms there is no such thing as old age! When considering any intervention (especially involving drug treatment) for a person of advanced years the strategy should be don’t treat the age, treat the person. 

In New Zealand it is estimated that 30% of people aged over 75 years of age are taking five or more medicines and around 10% are taking ten or more. The potential for medicine related morbidity and mortality in this population is great. But there are some straightforward steps that can be taken to reduce this risk. 

Fifteen medicines and eight diagnoses. How can you quickly assess the steps required to rationalise Mr Brown’s medicines? Is any rationalisation required at all? It’s not possible to do a comprehensive medicine review of regimens such as this in the context of a fifteen minute consultation. But there are some rules and tools that can simplify the process and help you identify some maximum impact interventions.

Associate Professor (Honary) Warren Smith 
Cardiology
Auckland City Hospital & Auckland Heart Group
www.heartgroup.co.nz 
warrens@adhb.govt.nz 
Phone 021-774-140

Limited use in lead extraction, AF ablation and refractory angina.

Our aging population combined with increasing obesity means coronary artery disease remains prevalent in older age groups frequently associated with multiple co-morbidities. Atrial fibrillation is also very common and no longer an arrhythmia to be prescribed digoxin and henceforth ignored . The advent of CT coronary angiography is changing the way we investigate chest pain and the associated calcium score promises to refocus risk profiling. Bio-absorbable stents, sensitive troponin assay, MRI compatible pacemakers and genetic screening for molecular causes of sudden death are all new developments which will change our practice. Attention to detail however remains the cornerstone of treatment of common problems such as angina, atrial fibrillation, blackouts and heartfailure and these aspects will receive attention via illustrative case studies in the workshop session.

Our aging population combined with increasing obesity means coronary artery disease remains prevalent in older age groups frequently associated with multiple co-morbidities. Atrial fibrillation is also very common and no longer an arrhythmia to be prescribed digoxin and henceforth ignored . The advent of CT coronary angiography is changing the way we investigate chest pain and the associated calcium score promises to refocus risk profiling. Bio-absorbable stents, sensitive troponin assay, MRI compatible pacemakers and genetic screening for molecular causes of sudden death are all new developments which will change our practice. Attention to detail however remains the cornerstone of treatment of common problems such as angina, atrial fibrillation, blackouts and heartfailure and these aspects will receive attention via illustrative case studies in the workshop session.

Erectile dysfunction and cardiovascular disease share the common risk factors of smoking, dyslipidaemia, hypertension and diabetes. Erectile dysfunction may predate cardiovascular disease and there is a growing body of evidence suggesting erectile dysfunction is a marker for future cardiovascular events. John will discuss the evidence linking these conditions and the resulting implications for our patients.

Dr Nikki Turner
Director, Immunisation Advisory Centre
University of Auckland
Phone: 09 373 7599 ext 82565
n.turner@auckland.ac.nz 

Immunisation is one of the strongest evidence-based medical interventions we have. Despite this, NZ currently has mediocre immunisation coverage and reasons for this are a mixture of issues around access to services, systems and a general lack of community confidence in immunisation generally. However many practices can and do maintain high immunisation coverage rates in their childhood population. A crucial component is a confident provider.

This presentation will focus on the key issues and resources that are useful for us as GPs and PNs at the practice level dealing daily with immunisation systems issues and parental and community concerns.

Immunisation is one of the strongest evidence-based medical interventions we have. Despite this, NZ currently has mediocre immunisation coverage and reasons for this are a mixture of issues around access to services, systems and a general lack of community confidence in immunisation generally. However many practices can and do maintain high immunisation coverage rates in their childhood population. A crucial component is a confident provider.

This presentation will focus on the key issues and resources that are useful for us as GPs and PNs at the practice level dealing daily with immunisation systems issues and parental and community concerns.

This is an interactive approach to the management of neck pain.

The Algorithm is your worksheet.

We will run you through this approach with plenty of ‘hands on’ experience, to consolidate what you already know, hopefully to learn some new skills and to simplify the management of neck problems in General Practice. The aim is also to have a pleasurable learning experience! We want you to ask questions at any stage and give us feedback.

We plan to have a discussion about the neck and it’s functions. We will consider neck pain, what is it, where is it felt and what is associated with it. What is its natural history? We will take a hands on approach to examination of the neck and allied structures. What are the other factors to be considered? What about imaging ,treatment, the non responder and referral? 

We trust these questions and more will be answered as we consider this important topic, and you will take home key strategies to help you the immediate day you return to practice and throughout the year.

This presentation examines the associations and causal links between oral diseases and systemic health, using the burden of inflammation framework. Examples will be given of common conditions where recognising these links and ensuring timely medical and dental care is essential.

This short presentation is part of the overall lasers in medicine module of the conference, and it highlights the ways that lasers are used for soft tissue surgery in the mouth and for procedures involving teeth, bone and dental implants. It illustrates some surgical soft and hard tissue procedures which can be done without anaesthesia, by using lasers to induce analgesic effects. Mention will also be made of photodynamic therapy and photoacoustic laser applications in dentistry. 

He then spent eighteen months as a fellow in Cardiac Radiology at Green Lane Hospital.

Phil is currently Director of Ultrasound at Middlemore Hospital, with full involvement in the MRI, interventional, angiographic services provided there.

He is a visiting specialist at Manukau Radiology Institute, and with The Ascot Radiology Group.

He has particular interests in musculoskeletal and breast imaging, and is involved in the Auckland Access To Diagnostics group, endeavouring to improve primary care access to imaging.

Overview of approaches to musculoskeletal problem solving with particular emphasis on primary care strategies, and available resources.

Plain film, ultrasound, MRI and CT scanning use of nuclear medicine and brief reference to CT PET.
Ultrasound and its practical application for common problems and utility in guiding musculoskeletal intervention.

This will be followed by hands on practical scanning using available laptop based ultrasound platforms. Patients with simple masses, and basic scanning techniques and normal anatomy around tendons and major joints.

Starting with manufacture & repair of safes & locks to system design, interface & implementation of security systems 

Branch Manage of Chubb NZ Ltd 10 years
National Technical Manager Chubb NZ 3 years

Completing a BCS in computer systems at Waiariki Institute of Technology 2010 specializing in Networks.

1400-1430 Staff Security 
1430-1515 Property Security & Systems
1515-1530 Discussion

Doug’s experience combines many years of mid market advisory, project type roles and now uses this to compliment his accounting, and strategic advisory work. This has resulted in growing number of corporate finance related projects as a natural consequence.

Doug has experience working with a wide range of clients in a variety of industries and has a partner leadership role in the following related areas: Strategic planning, Business structuring, Financial advisory, Business sales/acquisitions, Valuations, Capital raising and Succession planning.

In addition to his financial acumen, Doug has a long involvement in the following areas and continues to oversee these projects in a Quality assurance capacity: Feasibility studies, Business plans, Process design and improvement, IT selection and implementation, Project management, Management information systems and Financial modeling.

Other Interests
Doug is a board member of the Waikato Rugby Union
Doug is a trustee of the Grassroots trust
Doug is a founding board member of Habitat for Humanity

Direct Dial +64 7 834 7876 / 021 271 6344 
Email douwilson@deloitte.co.nz
Facsimile +64 7 838 4810 
Website www.deloitte.co.nz

Doug will provide some practical insights into the art of budgeting and the different methods used to establish performance goals and considerations that go into their determination. The budget will discussed from the perspectives of financial performance and position and resulting cash flows.

There will then be a logical follow on discussion and review around income generation and cost management to optimize shareholder return within a practice and a concluding section on, tools to help manage your finances, with a focus on line accounting applications, a new and exciting advent.

'Respiragene' is a personalised assessment for lung cancer risk. Respiragene is as simple as a cheek swab. 

Respiragene combines genetic and clinical information to create a susceptibility score for lung cancer risk in current and former smokers. 

In a pilot study of randomly selected smokers in Auckland preliminary results suggest that taking the Respiragene test motivates people to stop smoking. The 6 month quit rate among particiapants in this study was over 30% compared to the 4-5% of smokers overall who manage to give up smoking each year. The study has also confirmed that smokers want to know their individual risk of lung cancer.

Respiragene providers doctors with the opportunity to prioritize screening and detection efforts in their most at risk patients.

COPD is the leading risk factor for lung cancer but is underdiagnosed. Simple spirometry is available at the time of the Respiragene test.