Heart failure is characterised by fatigue, breathlessness and retention of fluid. The update of the National Institute for Health and Clinical Excellence chronic heart failure guidelines has simplified its management by using a stepped approach to investigation and treatment. In this article, we focus on the practical aspects of managing the two main symptoms associated with heart failure – oedema and breathlessness.
One in five strokes warn you they are coming: treat transient ischaemic attacks as emergencies
Transient ischaemic attack (TIA) is a powerful warning sign of an impending, and potentially disabling, stroke. It is important to understand differences between stroke and TIA, how the FAST test can help you recognise the signs, and the use of the ABCD2 score to assess the level of stroke risk. Treating TIAs as emergencies is critically important in preventing a full stroke so urgent referral to your local TIA service is best practice.
Supporting people with communication problems after stroke
Communication problems are one of the most common after-effects of stroke, affecting about one in three people. Losing the ability to speak or understand language – aphasia – is frightening and frustrating. This article offers insights and practical tips to aid communication.
What is motivating about motivational interviewing?
Have you ever felt like it is groundhog day? You are having the same conversation with the same patient and with the same outcomes. You are being very sympathetic and trying hard to help the patient make positive changes. But every suggestion you make garners the response: “Yes but I can’t do that because…”, “Yes but I’ve tried that”, “Yes but my friend said there was a tablet I could take”. That “yes but” is an indicator that motivational interviewing (MI) is likely to be helpful.
Thromboprophylaxis to prevent hospital-acquired thrombosis: an important opportunity for primary care
It is clear that hospital admission causes many preventable deaths from venous thromboembolism (VTE) yet the general public and, I would suggest, primary care health workers, still think of air travel as the main risk factor. Is there a role for primary care in helping to reduce the numbers of patients with hospital-acquired VTE?
Measuring your blood pressure: what you need to know about ambulatory blood pressure monitoring
The new NICE guideline on hypertension: using ambulatory blood pressure monitoring in practice
All change: Using ambulatory blood pressure monitoring to diagnose hypertension in primary care
Measuring blood pressure (BP) is one of the commonest tests we carry out in primary care – generally taking several measurements with a digital BP monitor on at least two clinic visits before diagnosing hypertension. Ambulatory blood pressure monitoring (ABPM) has traditionally been used in secondary care hypertension clinics, and in some larger general practices. But new guidelines from the National Institute for Health and Clinical Excellence are making ambulatory monitoring part of routine practice for the diagnosis of hypertension in primary care. What are the new guidelines recommending and why the change to ABPM?
Viewpoint
Twenty-five years ago, few healthcare professionals associated osteoporosis with an increased risk of broken bones, and there was no internationally recognised definition of the disease. There were no NHS dual X-ray absorptiometry scanners, treatment options were limited, and the care and support offered to those with osteoporosis was a long way below the standards delivered by health professionals today. There was also no UK-wide charity to raise awareness of the disease.
Taking control of urinary continence in women
Urinary continence problems are common in women, and result in significant costs to patients, carers and the NHS, both for treatment and coping strategies such as pads and appliances. Despite this, continence rarely gets the attention that some other, less prevalent conditions receive, and there is evidence of both under-diagnosis and inadequate management.
Put out the fire of vulvodynia
Most often described as a burning pain, vulvodynia is a chronic pain syndrome that affects all or part of the vulva. Diagnosis of this distressing condition is frequently delayed and management is challenging. But careful diagnosis and appropriate referral can help to minimise pain and enable women to regain control of their lives.
Pass it on: the reality of inherited cancer risk
Many people have close relatives with cancer, and the possibility of inherited risk is increasingly raised during a GP consultation, often by patients themselves. It is important to identify the small but significant proportion of people who are at greatly increased risk of developing cancer as a result of their family history. But most patients with a family history are not at higher risk, and can be managed in primary care.
