The White Paper, Saving lives: our healthier nation (1999), set out a target to reduce the death rate from coronary heart disease and related illnesses such as stroke by 40% in the under-75s by 2010; recent trends indicate that this target will be met. Although the past forty years have seen a significant reduction in age-standardised stroke mortality rates, stroke still accounts for around 53,000 deaths each year in the UK, with more than 9,500 of these occurring in the under-75s. This article reviews how we might reduce the huge burden of stroke by improving the management of transient ischaemic attack (TIA).
Thinking yourself free: understanding the principles of cognitive behavioural therapy
How are you feeling? If you had to measure how you feel on a scale from ‘grotty’ through ‘good’ to ‘great’, how would you rate yourself? More importantly, what do you think it was that decided how you feel today?
Stratifying stroke risk to guide treatment in patients with non-valvular atrial fibrillation
Antiplatelet (usually aspirin) and anticoagulant (usually warfarin) treatments are available to reduce the risk of stroke in patients with atrial fibrillation (AF) but both have potentially harmful adverse effects and warfarin can be time-consuming and expensive to monitor. Guidance exists for choosing between treatments but is often insufficiently detailed to support an informed choice about the risk and benefits. Prescribers and patients are often left with a choice between aspirin or warfarin, and aspirin – which is perceived to be safer and easy to use – is often chosen. This article explores the evidence for aspirin and warfarin in preventing stroke in patients with AF, and describes how we should change the way that decisions about treatment are made.
Drug treatment for atrial fibrillation
Irrespective of whether the atrial fibrillation is constant or occurs in paroxysms, that is, it is intermittent, the decision to administer antiplatelet drugs or anticoagulants should depend on the patient’s cumulative risk factors. These risk factors include age and previous medical history.
Vaginal thrush (Candidiasis)
Training for nurses improves care for women
Many advanced nurse practitioners (ANPs) are working in innovative ways to enhance patient care in general practice. But little specific training has been available for ANPs in women’s health. This article outlines how a training course was developed specifically to improve and maintain local ANPs’ competencies in managing women’s health in primary care.
The Forum takes action as the voice for women
The Primary Care Women’s Health Forum is now over one year old. When we met to establish the Forum, we set ourselves several aims and objectives. As we celebrate our first anniversary, our membership continues to grow and we are beginning to deliver on our major objectives: to be the voice for women and improve their healthcare.
Take a sexual history in primary care
Many primary care clinicians worry about how to take an appropriate sexual history. Raising the issue seems straightforward when a woman has symptoms or when contraception or cervical screening feature in a consultation. The challenge occurs when the possibility of sexual health issues may not be so apparent to the patient.
PCOS or overweight? Solving the diagnostic dilemma
Polycystic ovary syndrome (PCOS) is the commonest endocrinopathy, affecting 5-12% of women. Every aspect has been controversial from its nomenclature to its management. But accurate diagnosis based on consensus guidelines ensures that treatment can be tailored effectively to each woman’s symptoms and needs.
Older people and HIV: A call to action
Thanks to effective treatment, people with HIV are living longer than ever. Older people are now the fastest growing group with HIV in the UK, and as many as one in five adults accessing care is now aged over 50 years. But treatment does not mean cure, and a targeted approach to support is needed, as well as action to halt the growing numbers of older women and men affected by HIV.
Intrauterine system: informed choice for women and GPs
The intrauterine system (IUS) is a very effective long-acting reversible contraceptive (LARC) for appropriate women. But myths and misconceptions may cause some patients to opt for other, less reliable or suitable methods. Addressing frequently asked questions will help GPs to prescribe with confidence and enable women to make informed decisions about their contraception.
Identifying and supporting women with puerperal psychosis
The birth of a new baby is usually seen as a cause for celebration. But following delivery, a woman has a greater likelihood of psychiatric admission to hospital than at any other point in her life. This is often due to puerperal psychosis, a serious mental illness requiring prompt recognition and medical treatment. Primary care professionals are well placed to identify early symptoms to minimise risks to mother and baby.
