Homozygous familial hypercholesterolaemia (FH) is a rare disorder with a very high risk of premature cardiac death that must be diagnosed and treated from childhood onwards, usually with lifelong lipoprotein apheresis. Heterozygous FH is much commoner, with a high risk of cardiovascular disease in adults that can be prevented by early diagnosis and statin therapy.
HEART UK – The Cholesterol Charity – has provided editorial support and review of this sponsored FH series.This article was made possible by an unrestricted educational grant by Sanofi, who had no control over content.
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.
Emergency! Recognising and treating anaphylaxis
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.
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.
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.
Editorial
I looked through the topics in this issue of the journal and thought: wow, so many ways to kill ourselves younger than we really intended! I had also just heard a programme on the radio about the perils of alcohol consumption, especially in ladies ‘just like me’, and wondered if I should ever have a meal, a drink or sex again—it all sounded so risky.
Hepatitis B: A closer look at prevention and treatment
Liver disease is the fifth largest cause of mortality in England, after heart disease, cancer, stroke and respiratory disease. Of this ‘big five’, liver disease is the only major cause of death that is rising year on year, and it affects people at a younger age. It is also becoming clear that chronic hepatitis B infection is making an increasing contribution to the rising death toll from liver disease. Recently published NICE guidelines now give practice nurses and GPs a key role in the initial assessment and onward referral of patients to specialist services, and their subsequent care.
