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.
Editorial
It looks like it is going to be a long hard winter. The media have already been reporting restrictions on referrals and rising waiting times. It is likely that things can only get worse given the pressures on primary care trusts and local authorities. At times of economic stringency, women’s sexual and reproductive health can seem an easy target. But this is short-sighted and probably not costeffective given the UK’s high rates of teenage pregnancy and sexually transmitted infections. It is time for an approach to service configuration that goes beyond knee-jerk slash and burn.
Understanding end-of-life care in advanced Kidney Disease
People with advanced kidney disease are required to make many choices about their treatment throughout the journey of this disease. Opting not to have dialysis or to withdraw from treatment is a difficult decision and there are many factors that influence patients’ decisions. For those who choose not to have dialysis, the implications need to be understood by the patient, their family and carers and healthcare professionals involved in their care. This article provides an update on this important issue to equip primary care professionals with a clear understanding of end-of-life care for patients with advanced kidney disease.
Anaemia of chronic kidney disease
Chronic kidney disease (CKD) is a multifaceted disease that has several associated complications. Anaemia is one of the most common complications that can develop early in the course of the disease process. It is associated with increased mortality,increased hospitalisation rates, and reduced quality of life. Lower levels of kidney function are associated with lower haemoglobin (Hb) levels and a higher prevalence and severity of anaemia.
Early chronic kidney disease (CKD stage 3a): How to tell people they have the condition
Over the past five years there have been dramatic changes to the way in which people with chronic kidney disease (CKD) are being managed in primary care. As a result of policy changes there are now many more people with CKD being identified, especially those with stage 3A. This article deals with one of the most important issues for healthcare professionals when caring for people with early CKD – how to tell people that they have the condition and how to best manage it.
Improving the care of patients with chronic kidney disease
Chronic kidney disease (CKD) has a high mortality rate once it reaches the most severe stage. However, complications can be reduced and even prevented if it is diagnosed and treated earlier. Many people who develop CKD become symptomatic only when the disease is well established. By that point, the opportunity for some of the interventions aimed at minimising the impact of the disease has passed. Nurses working in general practice are well placed to recognise people at risk for CKD, diagnose them early and ensure that treatment is initiated and optimised to protect their renal and cardiovascular health.
Eating well for your kidneys
Diet and lifestyle strategies are essential in the treatment and possibly in the prevention of chronic kidney disease (CKD). Dietary modification plays a fundamental role in helping to control increased levels of blood electrolytes and metabolic waste productsthat are often seen as renal function declines. Dietary and lifestyle modification may not directly influence disease progression in CKD, but several lifestyle factors have been highlighted as important due to the significant influence they exert over associated factors such as diabetes and hypertension, which are two of the leading causes of CKD, and obesity.
Using drugs safely in chronic kidney disease
Chronic kidney disease (CKD) affects renal drug elimination and other important processes involved in drug disposition, including absorption, drug distribution and non-renal clearance. As a result, the reduced renal excretion of a drug or its metabolites can cause toxicity and the sensitivity to some drugs is increased even if elimination is unimpaired.
Chronic kidney disease and QOF: Ticking the right boxes for the right reasons
The Quality and Outcomes Framework (QOF) was implemented in 2004 with the aim of ensuring that all patients had access to standardised, evidence-based care for their long-term condition. Points are awarded for meeting certain standards in each of theseconditions and the number of points earned is translated into money that is paid to the practice. Chronic kidney disease (CKD) is one of the long-term conditions with QOF points for registering and monitoring.
Proteinuria: Should it replace cholesterol as a marker for people at high risk of CVD?
We have all seen paintings of early physicians looking at flasks of urine to give an indication of a person’s health. And most of us can remember days of rows of urine pots lined up to test for new patients in primary care and in hospital outpatient clinics. We may assume that those days have gone in the era of blood testing and CT scans. So why are we suggesting that urine testing has a central role in finding patients with previously undiagnosed cardiovascular disease?
