A patient may present at any time suffering from the signs and symptoms of anaphylaxis, (a severe, life-threatening, generalised or systemic hypersensitivity reaction). This article explains how to recognise anaphylaxis and how to treat anaphylactic shock. It also outlines the responsibilities of practice nurses and other members of the primary healthcare team after a patient has had a suspected anaphylactic reaction.
Editorial
Well, how fast things change! The latest figures show that a massive proportion of practice nurses and nurse practitioners are going to retire in the next few years—me included, I guess. I am very aware that this exodus is already starting to have an impact on primary care, as I am receiving requests for advice from brand-new practice nurses, who may be established nurses but are not general-practice prepared. This is scaring me and should frighten everyone else.
Whatever has happened to QOF?
After several years of incremental adjustments and more new indicators, massive changes have been made to the new Quality and Outcomes Framework (QOF). So let us have a look at the facts and think about the implications of these changes for our daily routines from April.
How to eat well if your appetite is poor
www.leedscommunityhealthcare.nhs.uk
Food first: supporting adults with poor appetites
Malnutrition is a cause and consequence of disease, and affects at least 3 million adults in the UK, most of whom live in the community. By helping these vulnerable patients to eat the right types of food rather than use inappropriate supplements, practice nurses can not only help prevent and treat malnutrition, but also save the NHS millions of pounds each year.
Why and when to test for anaemia
In primary care, sending blood samples to the laboratory is so routine that it is easy to take these tests for granted. But it is important to understand the purpose of each test; when it is appropriate; and how to act on the results. Here red blood cell tests and their role in identifying possible causes for anaemia are discussed.
A ‘wasted decade’ for hormone replacement therapy?
Over 10 years ago, publication of Women’s Health Initiative (WHI) studies affected both public perceptions and our clinical prescribing of hormone replacement therapy (HRT). Front-page reports of higher risks of heart attacks, stroke and breast cancer led to around a million women in the UK stopping HRT, many without medical advice or clinical assessment. Since then, new evidence has emerged, much of which does not support the earlier alarming headlines.
Telemonitoring for heart failure: experience of the Gloucestershire Telehealth Programme
Remote monitoring is an emerging model of care in heart failure (HF) which has been shown to be clinically beneficial. In this study, patients were recruited to a new telemonitoring programme after referral to a community HF service. Following enrolment, there was a 58% reduction in the risk of HF admissions (0.71 vs. 0.30 per year, p<0.001). During the programme patients received, on average, nine home visits, eight telephone calls and three clinic appointments per person per year.
After brain attack: the new stroke guidelines
Most people now survive a first stroke, but many patients are left with significant disability. In this article, our very own BATman ‘goes through rehab’ to review recently published NICE guideline. This aims to ensure that all stroke survivors have access to effective, individualised rehabilitation, both in the hospital and during long-term follow-up in the community.
Androgens really matter to older men
Androgens such as testosterone, male sex hormones produced by the testicles, control the development and maintenance of masculine characteristics. Reduced testosterone levels—known as male hypogonadism—may cause both physical and psychological effects. These effects may be severe enough to compromise a man’s general wellbeing and his sex life in particular. But the decision to replace testosterone is not always straightforward, and patients need careful monitoring before and after starting treatment.
Managing venous thromboembolism in the 21st century
Venous thromboembolism (VTE) occurs when a blood clot forms in the wrong place, and it can cause serious illness or death. Treatment of VTE is currently very labour-intensive for nurses and awkward for patients. Novel treatments are more expensive and have their own risks. But this new approach is less reliant on nurse time and more straightforward for patients, and seems likely to become the norm during the next few years.
Ambulatory blood pressure monitoring: from guideline into practice
NICE now recommends that 24-hour ambulatory blood pressure monitoring (ABPM) rather than repeat clinic measurements should be the gold-standard test for diagnosing high blood pressure. This article considers the practicalities of using ABPM in the clinic, including advice to pass on to patients to ensure accurate readings.
