For most women, pregnancy is a normal, life-affirming process, but there may be complications for some mothers and babies. Raised blood pressure can harm both babies and mothers-to-be, and is a leading cause of maternal death as well as fetal loss. These deaths are avoidable, so it is vital for GPs and practice nurses to recognise and know how to manage hypertension in pregnancy.
Choosing Novasure® for endometrial ablation
Heavy menstrual bleeding (HMB) prompts one in 20 women aged 30-49 years to visit their general practitioner. There are many treatment options for HMB, but endometrial ablation is recommended before hysterectomy when symptoms do not respond to medical treatment. This article discusses NovaSure, a method of endometrial ablation that may have advantages for some patients.
Safeguarding, consent and confidentiality
Safeguarding – protecting a person’s health, wellbeing and human rights to enable them to live free of harm, abuse and neglect – is fundamental to health and social care. But sometimes in clinical practice the situation and the appropriate response are not clear-cut, and careful consideration is needed before sharing concerns about a young person’s sexual activity and relationship.
Medical termination of pregnancy
In the UK, under the Abortion Act 1967, an abortion (termination of pregnancy; TOP) can only be carried out by a hospital or a specialised licensed clinic.
Therapeutic review: Prescribing DPP-4 inhibitors – Are there clinically relevant differences?
There are now four agents in the new class of glucose-lowering agents called dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) available in the UK. They are, in order of launch in the UK, sitagliptin, vildagliptin, saxagliptin and linagliptin. Several others are in the pipeline and are likely to be launched before long. This article will discuss their place in treating diabetes and the differences between them.
Current statin treatment, DNA testing and cascade testing of UK patients with familial hypercholesterolaemia
50% lowering of LDL-C from the baseline value. Half of all patients and 53% of women with CHD failed to achieve the target >50% reduction in LDL-C. There is a major lack of family “cascade” testing. Funding for DNA testing and cascade testing is lacking in many parts of the UK.
Fatal epistaxis: case report and review of the trigemino-cardiac reflex
The trigemino-cardiac reflex can result in potentially fatal apnoea, hypotension or dysrhythmia when thesensory branches of the trigeminal nerve located in the nasopharynx are stimulated. We report the occurrenceof this reflex, following nasal packing for epistaxis, that led to respiratory and circulatory arrest.
A patient with Lyme disease: complete heart block treated with antibiotics
Taking steps to improve care of patients with dementia
Taking steps to improve care of patients with dementia – Zoë Elkins, Penny Garner
Dementia is common. This article describes specific ways to improve communication these patients, including the SPECAL photograph album and observational tracking.
The challenge of changing lifestyle behaviours
The challenges to changing lifestyle behaviours and delivering lifestyle support in primary care are described here. The role of primary care in delivering evidence-based interventions for lifestyle change is also discussed.
Home delivery plans raise professional concerns
Perinatal healthcare professionals in the UK have given a mixed reception to Government plans to increase the numbers of home births.
A survey of 831 midwives, GPs, consultant obstetricians/gynaecologists and consultant neonatologists/paediatricians in the Eastern NHS Region received a wide range of responses concerning their experience of, and enthusiasm and support for home birth:
Experiences of home birth
7 (5-8)
5 (3–7)
5 (2–5)
2 (1–3)
Enthusiasm for home birth
9 (8–10)
3 (3–7.5)
5 (3–7.5)
4 (3–5)
Support for Government plans to increase home delivery rates
8.5 (7–10)
5 (2–6)
5 (2–5)
3 (2–5)
* All scales 0–10 from strongly negative (0) to strongly positive (10); data are median (IQR) ** Consultant obstetricians and gynaecologists † Consultant neonatologists and paediatricians
Government moves to make home births more accessible also elicited a range of responses from the different disciplines. Midwives generally reported positive experiences of home delivery and were more favourable about the concept of home birth than any of the other professionals.
The authors suggest that negative experiences and opinions of perinatal healthcare professionals may impact on women’s uptake of home delivery. These concerns will need to be addressed if the Government plans to increase home delivery rates are to succeed.
McNutt A et al. Int J Gynecol Obst 2012:119(Suppl 3):S419(O444)
Botulinum toxin: effective for overactive bladder in clinical practice
Botulinum toxin A effectively treats symptoms of overactive bladder (OAB) with high rates of patient satisfaction, according to questionnaire study from a UK centre.
A total of 60 women (median age 59 years) with OAB treated at University Hospital of North Staffordshire received botulinum toxin injections into the detrusor muscle. All had been unsuccessfully treated with urinary incontinence medications and most had received physiotherapy.
According to results of a questionnaire sent after botulinum toxin treatment, 50% of the patients experienced improved symptoms within one week, with a further 30% showing improvement between two weeks and four months after the procedure. Symptom improvement lasted between zero and nine months for 53% of the patients. Three-quarters of the patients noted that the botulinum toxin injections were “very effective, effective or moderately effective” in treating their symptoms.
Patients also expressed high satisfaction, with 73% commenting that the injection exceeded or met their expectations and 80% saying they would repeat the treatment if required.
These results suggest that botulinum toxin A may provide a valuable alternative treatment for OAB. Current NICE guidance advises that botulinum toxin A should be only used in women who have not responded to lifestyle interventions, bladder retraining and pharmacological treatment and who are willing and able to self-catheterise.
Rigby J et al. Int J Gynecol Obst 2012:119(Suppl 3): S463 (A0573)
NICE guidelines on the management of urinary incontinence in women. October 2006. http://www.nice.org.uk/nicemedia/live/10996/30282/30282.pdf
