“There are two objects of medical education: to heal the sick and to advance the science.”
12 minutes and the simple seven
Exercise is a preventive tool in combating cardiovascular disease, type 2 diabetes and obesity: an extra 12 minutes a day could make a big difference.
Nothing stays the same in medicine – or the QOF
“The hardest conviction to get into the mind of a beginner is that the education upon which he is engaged is not a medical course but a life course, for which the work of a few years under teachers is but a preparation.”Sir William Osler (1849-1919), from The Student of Medicine.
Cardiovascular morbidity and mortality in schizophrenia: implications for primary care
People with schizophrenia have substantial premature mortality compared to individuals without schizophrenia. They also have a wide range of co-morbidities and multiple physical health conditions but are less likely than people without schizophrenia to have a primary care record of cardiovascular disease. This suggests a systematic underrecognition and under-treatment of cardiovascular disease, which may contribute to the increased mortality seen in this vulnerable patient group.
Time to GRASP heart failure in primary care
Since the introduction of the Quality and Outcomes Framework (QOF), GPs have been incentivised to keep a register of patients diagnosed with heart failure (HF). Such registers are only effective if they are audited regularly, since they are likely to contain errors and omissions. GRASP-HF is a new tool designed to help busy practices achieve a systematic approach to the identification, diagnosis and management of patients with HF.
Suspected VTE and referral outcomes: results of a general practice audit
In-house D-dimer testing and the Wells Score combined meant that cases were referred to secondary care only when patients were strongly suspected to have VTE or pulmonary embolism. Some 86% of VTE cases had properly documented risk assessment.
An update on GRASP-AF
Through the support of NHS Improvement, Guidance on Risk Assessment for Stroke Prevention in Atrial Fibrillation (GRASP-AF) has been rolled out nationally. Nearly 2,000 practices have adopted the GRASP concept, representing an overall population of 13 million.
Guidance on optimal management of stable angina in general practice
For most people symptoms can be controlled by optimal medical management and healthy lifestyle choices. Revascularisation gives symptom relief but is not without risk, and its long-term benefits remain uncertain.
The new European Society of Cardiology guidelines on heart failure: moving beyond NICE guidance
The 2012 ESC guidelines on heart failure, published only two years after the updated NICE guideline, spell out therapeutic advances about which doctors need to be aware. They include recommendations on mineralocorticoid receptor antagonists (MRAs), ivabradine and cardiac resynchronisation therapy (CRT).
Medication adherence in cardiovascular disease: how to address one of the challenges of preventive medicine
Drugs don’t work in people who don’t take them. This is a problem that affects 57% of all patients prescribed drugs to prevent heart attacks and strokes, according to a recent meta-analysis combining data from more than 370,000 patients.
Heart rate control in people with heart failure: education may improve outcomes
Heart rate appears to be a marker for optimal medical therapy in heart failure, and a key determinant of hospitalisation. This study compared practices using the local enhanced service (LES) for heart failure against those not delivering the LES. Education and heart rate control seem to influence hospitalisation rates.
An intervention trial for patients with hyperglycaemia and acute coronary syndrome: How effective is lifestyle advice?
Abnormal glucose metabolism in people admitted to hospital experiencing an acute coronary syndrome (ACS) strongly predicts development of type 2 diabetes and future cardiovascular events. This paper describes a prospective nine-month parallel design randomised intervention trial involving people admitted to the Wellington Regional Heart and Lung Unit with ACS and hyperglycaemia.
